TKG PACT Executive Briefings - 3-Minute Market Insights The Kinetix Group, Powered by Petauri

The term therapeutic inertia describes the failure of health care providers to initiate or intensify therapy when it is clearly indicated by established guidelines. The term has largely been applied to the management of blood pressure, blood sugar, and cholesterol, by primary care physicians who recognize the need for their patients to control these conditions but fail to act sufficiently to achieve the guideline recommended therapeutic targets. Despite clearly articulated, evidence-based, clinical guidelines, some physicians fail to translate this knowledge into practice. We believe that therapeutic inertia plays a significant role in delaying the adoption of many new treatments. 
Most practitioners function within a “personal comfort zone” of prescribing behavior, being reluctant to take unnecessary risks with new drugs. There is a natural “learning curve,” where clinicians need to learn the side effect profiles and characteristics of new drugs, as well as to be assured that the drugs perform as promised.
You may download the full TKG PACT Executive Briefing highlighted in this episode, at Executive Briefings | TKG PACT
We welcome your suggestions, ideas, and requests for Executive Briefing topics of interest. Please email us at Insights@thekinetixgroup.com. 

Since 2016, 13 states have passed Drug Price Transparency Laws focused on enabling state policymakers to understand opaque drug pricing and payment systems to formulate policy solutions to high prices, while also creating the data infrastructure to realize those policy solutions. 
Most of these state programs require reporting from manufacturers when they increase the Wholesale Acquisition Cost (WAC) of a drug above a certain threshold or if they introduce a drug with a high launch price.  
Since 2020, 8 states have enacted Prescription Drug Affordability Boards often referred to as P-DABs, entities with the authority to review high cost drugs and in some states set an upper payment limit to ensure no one pays more than that amount in the state.

You may download the full TKG PACT Executive Briefing highlighted in this episode, at Executive Briefings | TKG PACT
We welcome your suggestions, ideas, and requests for Executive Briefing topics of interest. Please email us at Insights@thekinetixgroup.com. 

On January 17th, 2024, CMS published the CMS Interoperability and Prior Authorization Final Rule, to improve the electronic exchange of health care data as well as to streamline prior authorization processes. This final rule also adds a new measure for merit-based incentive payment system or MIPS eligible clinicians.
Beginning in January 2026, health insurers participating in federal programs including Medicare advantage and Medicaid, must respond to expedited (that's "urgent") prior authorization requests within 72 hours and standard (or "non-urgent") requests within seven days. Insurers must also include their reasons for denying a prior authorization request and will be required to publicly release data on denial and approval rates for medical treatment.

You may download the full TKG PACT Executive Briefing highlighted in this episode, at Executive Briefings | TKG PACT
We welcome your suggestions, ideas, and requests for Executive Briefing topics of interest. Please email us at Insights@thekinetixgroup.com

Today’s topic is the Federal No Surprises Act.
The Federal No Surprises Act is intended to protect consumers from unexpected medical bills that occur when a patient unknowingly receives medical services from physicians and other providers who are outside of their health insurance network; in other words, healthcare providers who are not “in network”. 
The law protects consumers specifically from surprise medical bills in three main scenarios:
1.    Emergency care from an Out-of-Network provider at an In-Network facility;
2.    Any care from an undisclosed Out-of-Network provider; and
3.    Uninsured or self-pay patients from unknown costs.


You may download the full TKG PACT Executive Briefing highlighted in this episode, at Executive Briefings | TKG PACT
We welcome your suggestions, ideas, and requests for Executive Briefing topics of interest. Please email us at Insights@thekinetixgroup.com

Welcome to our new and revised market insights podcast format, where we have renamed our program the TKG PACT Executive Briefing. The new format will be condensed into 3-minute episodes of market insights, where we highlight one of healthcare’s critical market access issues, policies, challenges, or trends.
We hope you enjoy this new “3-Minute Market Insights” format and hope that this resource provides helpful information in smaller, easier to digest, sound bites. Most of these TKG PACT Executive Briefings will have a downloadable PDF that you can access on our website. Instructions will be given with each episode. Look for a new episode to be available about every other week.
Need more information? Or have suggestions for topics of interest? Please email us at Insights@thekinetixgroup.com

Telehealth Policy Gaps: Challenges with Remote Prescribing

On May 11th, the Public Health Emergency (PHE) and some of the provisions that supported the explosive growth of telehealth, will expire, leaving telehealth providers scrambling to address some of the challenges of proving remote care.
My special guest in this episode is Dori Martini, Vice President of Operations and Regulatory Affairs for Circle Medical, a large, multi-state, contemporary, personalized primary care practice that offers high quality care, both in person, and via telemedicine. They are an affiliate of the University of California at San Francisco.

Dori has an impressive understanding of the gaps – especially policy gaps - becoming evident in the day-to-day use of telehealth. In this episode, she shares some unique “best practices” in working around a few of the gaps and some practical ideas for managing your remote patients.