EP265: The What, the How, and the Questionable Why of Digital Therapeutic Formularies, With Randy Vogenberg, PhD

There is a lot going on with digital health tools these days. Which ones are the good ones and which ones are nothing burgers packaged up in beautiful marketing? That’s a good question, and it would be nice to have a go-to source for such information.

Some parties — mainly PBMs [pharmacy benefit managers] and to some extent payers and providers — recognize that this actually would be nice, and they see that creating digital formularies could be an opportunity to grow revenue for their shareholders by meeting a market need potentially and offering additional services to the marketplace. But the term formulary implies more than just some kind of health technology assessment. It implies, at least at some level, the promise of reimbursement.

But given how local health care tends to be, especially when considering patient populations and the “bottom-up” nature of the doctor-patient relationship, here’s the question I have for you: Is it even possible for a third party, disconnected from the care setting and the patient, to “top-down” select the technology which will be used and reimbursed … especially in the age of consumerism?

For more on the intersection of patients and provider digital tool selections, listen to episode 250 with Vicky Tiase from NewYork-Presbyterian. 

In this health care podcast, I am speaking with Randy Vogenberg, PhD. Randy suggests that a more crowdsourced approach to digital health tool selection might be in order here. He says that those who are using the tools really need to have a seat at the table. He says that possibly the “formulary” within any given organization should be more of a consensus among stakeholders and less of a mandate from on high.

But there are a lot of wrinkles … like, lots of wrinkles.

Randy Vogenberg is board chairperson at the Employer-Provider Interface Council. He is principal over at the Institute for Integrated Healthcare.

You can learn more at iih-online.com, epicouncil.org, and hope.rutgers.edu. 

Randy Vogenberg, PhD, is principal at the Institute for Integrated Healthcare, co-leader for the National Employer Initiative on Specialty Pharmacy, and cofounder of the National Institute of Collaborative Healthcare (NICH). He is a health care expert on health system delivery and economics as well as health-related solution innovation research. Most recently he partnered with the Hospital Quality Foundation in developing the Employer-Provider Interface Council (EPIC). His broad hospital and managed care expertise includes current or future trends around financing, market excellence, and benefit management or design.

A leader and highly requested speaker on applied health systems research, he has authored programs or books on self-funded health benefits, managed markets, hospitals, and integrated medical-pharmacy benefit management. His academic relationships include Rutgers HOPE Center and former senior fellow at the Jefferson School of Population Health. Currently, he is an adjunct professor at the University of Rhode Island College of Pharmacy and Presbyterian College School of Pharmacy as well as the University of Illinois College of Pharmacy.

02:51 What a digital formulary is. 03:52 PBMs and digital formularies. 04:41 The changing landscape of PBMs and digital health. 06:00 The intersection of PBMs and digital health tools. 10:18 “Arbitrage, full on.”—Mark Blum, from America’s Agenda. 12:21 The inherent differences between a health plan and a PBM. 15:58 The original purpose of a pharmacy/therapeutics committee. 16:58 “There’s a lot of change happening, is the bottom line.” 18:18 The risk assessment behind medical software. 18:29 Harm vs digital therapeutics and digital medicine. 18:52 Cybersecurity in digital therapeutics. 19:08 Reimbursement in digital therapeutics. 19:43 The question of “how” in reimbursement. 20:37 “How do we reset health care in just one state, let alone the whole country?” 22:13 Taxpayers, patients, and employers vs the health care industry. 22:56 The slow move away from fee for service, and why. 24:13 The timeline for incorporating digital tools into the health care system. 24:33 “It’s a real problem for the consumer side.” 25:09 “What’s really going to be worthy of reimbursement?” 25:50 “There’s only two major payers in the health care system … that’s the government, and it’s the private sector employers and state programs or unions.”

You can learn more at iih-online.com, epicouncil.org, and hope.rutgers.edu.