Digital health technologies (DHTs) are a broad and rapidly innovating class of interventions with distinctive pathways for development, regulatory approval, uptake and reimbursement. Given the unique nature of DHTs, existing value assessment frameworks and evidence standards for health technologies such as drugs and devices are not directly applicable. The value assessment framework presented here describes a conceptual model and associated methods to guide assessments of DHTs. The framework seeks to accomplish two goals: to set evidence standards that guide technology developers to generate robust evidence on their products; and to provide reviews that help organizations adopt high-impact DHTs with the strongest evidence for delivering improved clinical outcomes and cost savings. This assessment framework will serve as the roadmap for future evaluations of DHTs by the Institute for Clinical and Economic Review (ICER) and the Peterson Health Technology Institute (PHTI). We believe that all stakeholders will benefit from comprehensive and explicit standards of evidence on the different dimensions necessary to understand the value of DHTs.

New Institute for Clinical and Economic Review (ICER) analysis evaluates potential risks and advantages of reforms to current policies related to white bagging, brown bagging, and site of service policies that aim to address provider markup in the commercial insurance market.

An estimated 90% of people living with Parkinson's disease (PD) in the US are covered by Medicare health insurance. How these beneficiaries use and engage the health care system is important to understand in the face of a rapidly growing PD population. Here, we analyzed health care utilization patterns of those with a PD diagnosis enrolled in Medicare in 2019. By our estimates, PD beneficiaries number 685,116 or 1.2% of the total Medicare population. Compared to the overall Medicare population, 56.3% are male (vs 45.6%), 77.9% over age 70 (vs 57.1%), 14.7% people of color (vs 20.7%), and 16.0% are rural residents (vs 17.5%). Our analysis identified significant disparities in care. Surprisingly, 40% of PD beneficiaries (n = 274,046) did not see a neurologist at all during the calendar year and only 9.1% visited a movement disorder specialist (MDS). Few Medicare beneficiaries diagnosed with PD use recommended services such as physical, occupational, or speech therapy. People of color and rural residents were least likely to access a neurologist or therapy services. Despite 52.9% of beneficiaries being diagnosed with depression, only 1.8% had a clinical psychology visit. Our findings emphasize the need for further research on population-specific barriers to accessing PD-related health care.

The number of people living with Parkinson’s disease (PD) is expected to rise in the coming years. This study analyzed health care utilization patterns of Medicare beneficiaries with a PD diagnosis (ICD-10 code G20) who were enrolled in 2019. Utilization analysis included PD-related specialists and primary care physicians, therapy services, and mental health services. We found 685,116 (1.2%) Medicare beneficiaries had PD (56.3% male, 77.9% over age 70, 85.3% White, and 16.0% rural residents). Few Medicare beneficiaries with PD sought care from a movement disorder specialist (MDS) (9.1%); another 50.9% visited a general neurologist. Results reveal low utilization rates for therapy and even lower rates for mental health services. Overall healthcare utilization varied significantly by demographic group with women, people of color, and rural residents being less likely to access specialist care. Our findings emphasize the need for further research on population-specific barriers to accessing PD-related health care.

Scientific advancements, new US FDA approval pathways and limited competition have contributed to rapid growth in the number of approved rare disease treatments in recent years. While the rising numbers of orphan drug approvals are a sign of success, the rapid growth in approved rare disease treatments has created concerns about the pricing of orphan drugs and their cumulative affordability to the health system. To support efforts to build a policy and practice infrastructure that drives innovation within a platform that is affordable to patients and the health system, this paper provides an analysis of potential risks as well as advantages of reform options related to drug development, pricing and coverage.

As people age and require more assistance with daily living and health needs, a range of housing and care options is available. Over the past four decades the market for seniors housing and care-including assisted living and independent living communities-has greatly expanded to accommodate people with more complex needs. These settings provide housing in a community environment that often includes personal care assistance services. Unfortunately, these settings are often out of the financial reach of many of this country's eight million middle-income seniors (those ages seventy-five and older). The private seniors housing industry has generally focused on higher-income people instead. We project that by 2029 there will be 14.4 million middle-income seniors, 60 percent of whom will have mobility limitations and 20 percent of whom will have high health care and functional needs. While many of these seniors will likely need the level of care provided in seniors housing, we project that 54 percent of seniors will not have sufficient financial resources to pay for it. This gap suggests a role for public policy and the private sector in meeting future long-term care and housing needs for middle-income seniors.

Osteoporosis is highly prevalent worldwide and is associated with increased risk of low trauma fracture (LTF) [1], increased morbidity and mortality [2]. Major advances in diagnosis, management and BMC Nursing 2017, 16(Suppl 1):32 Page 3 of 11 prevention of secondary fractures have occurred [3] but implications for acute nursing care are less well documented. This project investigated practitioners’ experiences of caring for people with osteoporosis, knowledge of the disease, explored implications for moving and handling, reported patients’ care experiences, and developed education for frontline staff.