- Optimizing Physician Practice Acquisitions
- Social Determinants in a New Era of Healthcare
- Behind the Curtain: Premier at HIMSS17
- A Dozen Population Health Developments to Watch in 2017
- A Matter of Life and Death: Advance Care Planning
- Value Analysis Process: Why Each Step Counts
- Re: Healthcare
- Rethink: Healthcare in 2017
- Building the Ideal Construction Project Team
- Biosimilars 101: Facts, Risks and Opportunities
With the new administration and Congress moving forward at a rapid pace, many in the healthcare industry are looking for consistency amid the tide change. What certainties exist when a new administration is considering a different approach to healthcare reform? Unquestionably, the pace at which hospitals acquire physician practices is set to continue and potentially increase as the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) Quality Payment Program drives physician practices to operate under a new value-based reimbursement system. When faced with the need to acquire a physician practice, how can healthcare systems evaluate both the clinical and economic value of the acquisition target, in light of the changing healthcare climate? PRE-ACQUISITION EVALUATION PHASE Acquiring physician practices often involves purchasing hard assets, such as real estate, furniture and equipment, assumption of existing leases, supplier contracts and payer agreements and more. These considerations should be addressed in the pre-acquisition phase during the determination of the fair market value (FMV) of the targeted practice. In addition to determining FMV, there is more to consider during the pre-acquisition phase. Typically, upon acquisition and employment of physicians by hospital organizations, the following may be observed: * Reduced productivity and poor compensation alignment; * Increased practice expenses (e.g. increased support staffing levels); * Reduced practice revenue streams (e.g. ancillary & technical services); and * Other impacts to profit or loss. In addition, penalties and bonuses under the Merit-based Incentive Payment System (MIPS) follow the physicians. Health systems will need to develop internal mechanisms for evaluating performance and estimating financial impact, as well as potentially creating employment contracts that take these issues into account, or be prepared to absorb the impact post-acquisition. POST-ACQUISITION OPTIMIZATION PHASE After your organization has closed on a newly acquired physician practice, how do you assess whether or not the acquisition is creating the synergies needed for the expected return on investment? Several key metrics can help you assess your performance, including: * Physician Productivity * Practice Expenses * Provider Access / Patient Flow * E&M Coding * Ancillary & Technical Services * MIPS Penalties and Bonuses ROUTINE AND ONGOING STEPS TO PRACTICE OPTIMIZATION Maximizing practice performance is a science as well as an art. Click here to learn more about the ten key steps that any physician network executive should be considering as they work to optimize the operational and financial performance of employed physician practices. AUTHOR INFORMATION
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Gregory M. Schulz, FACHE, is Director of Physician Practice Management Advisory Services at Premier Inc. and has over 30 years of business and healthcare management experience. Greg welcomes the opportunity to discuss any issues or questions you may have about your employed physician network. Connect with him on LinkedIn.
As the saying goes, we are products of our environment. SOCIAL DETERMINANTS OF HEALTH, or conditions in which people live, learn, work and play, can all influence how healthy we are. Everything from the quality of schooling to the cleanliness of water can impact a community’s overall health. _Healthy People 2020__, _a program for improving the nation’s health, developed a framework to reflect five key areas (determinants) to categorize the social determinants of health: * Economic Stability * Education * Social and Community Context * Health and Healthcare * Neighborhood and Built Environment Social structures and environmental conditions in these key areas can result in unequal care delivery, which partly explains why some Americans are healthier than others. And as the movement toward managing targeted patient populations continues to gain momentum, social determinants of health are increasingly seen as critical components of care management in a value-based care environment. Just how important are social determinants of health? One analysis found that clinical care was responsible for as little as 10 percent of the impact on health outcomes in some states. _HOW DO I IMPROVE CARE FOR PEOPLE THAT ARE AFFECTED BY THE SOCIAL DETERMINANTS OF HEALTH?_ Providers have identified and continue to test a number of programs and initiatives to manage the social determinants of health. These include, but are not limited to: CARE MANAGEMENT A number of health systems have created care teams of nurses, social workers and community health workers to provide high-touch care to high-cost patients. PARTNERING WITH COMMUNITY ORGANIZATIONS Joining forces with local organizations, including faith-based communities, schools, and organizations created to help those in poverty, to create a safety net for patients is another approach to managing social determinants of health. These initiatives expand the network of groups with a stake in patients’ health. HEALTH EDUCATION Providing appropriate healthcare education to patients and staff is one of the easiest ways to influence health decisions made outside of the hospital. Staff should have an in-depth understanding of health literacy issues and cultural sensitivities. ASSET MAPPING Bringing together community groups that provide similar services and recording detailed information on those services can forge relationships and create important networks for providers and patients. _IS THERE A FINANCIAL BENEFIT?_ Many hospitals and health systems are stretched thin financially on a number of levels. Initiatives that are not affordable are often simply off the table. How can managing, or not managing, social determinants of health impact the bottom line? READMISSION RATES: Implemented effectively, programs that manage social determinants of health will reduce readmission rates for high-utilizers, thus decreasing associated penalties. CAPITATED PAYMENTS: Health systems implementing programs with capitated payments for beneficiaries will create savings by reducing unnecessary hospitalizations. UNCOMPENSATED CARE: Targeted care management for specific populations can provide patients with the resources they need to use the hospital appropriately; reducing uncompensated care while increasing preventative care. STATE AND FEDERAL GRANTS AND INITIATIVES: A number of funding sources are available on the state and federal level for the implementation of programs that address social determinants of health. A lack of aligned incentives can pose many challenges for stakeholders interested in addressing the social determinants of health. A return on investment may be realized if these services target the appropriate patients. Putting policies in place that positively influence social and economic conditions can improve health for a vast number of people over time. Providers can begin thinking about areas of opportunity when building out their population health strategy in this new era of care delivery. Need help working on your own population health management plan? Our team of expert consultants, recently recognized as Best in KLAS in value-based care consulting, can help accelerate your transition to effective population health management. AUTHOR INFORMATION
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Beth Anctil leads the Clinical Transformation Team in Population Health Advisory Services for Premier Inc. With over 35 years of healthcare management experience spanning settings across the continuum of care, she has proven leadership skills and success in fully deploying initiatives to transform models of care. Connect with her on LinkedIn.
If you’re just planning on attending HIMSS17, you can more than likely pack your bags in less than an hour. But if you’re a presenter or exhibiting vendor, you’ve probably spent months preparing to dazzle the masses. In the days leading up to the event, the HIMSS exhibit hall is filled with hundreds of multi-layered meeting spaces being built from the ground up; dozens of cranes hanging lights, monitors and signage; parades of golf carts buzzing from one end of the floor to the other; and vendors….lots and lots of vendors preparing for the thousands of visitor eyes on their final display. Premier is no exception when it comes to preparing for HIMSS17. We aim to create an exhibit that not only showcases our newest and most cutting edge solutions and technologies, but that is also engaging and enjoyable for exhibit hall attendees. CAN’T WAIT UNTIL HIMSS17? Here’s our current lineup, all powered by information on 40 percent of U.S. hospital discharges and more than $50 billion in annual supply chain spend. ENTERPRISE ANALYTICS - We’re helping healthcare organizations acquire, integrate and leverage their vast array of data to improve outcomes and their bottom lines. *HIMSS17 TIP: Ask for Vlad. He'll demonstrate one of our recently launched solutions that marries clinical and cost data to help providers eliminate high cost supplies without adversely impacting outcomes. CLINICIAN PERFORMANCE MANAGEMENT – We’re projecting “MACRA” will be most used word at the conference. It’s certainly top of mind for us and is one of the driving forces behind our recently-launched Clinician Performance Management solution that helps healthcare organizations monitor and manage clinician performance across the continuum. *HIMSS17 TIP: Ask for Sarah. She’ll show you how this solution is helping providers prepare to thrive in the Quality Payment Programs set forth by MACRA. ENTERPRISE RESOURCE PLANNING (ERP) - Multiple health system surveys indicate legacy ERP systems are not prepared for the coming challenges facing health systems. That’s why we’ve built a secure, cloud-based ERP solution exclusively for healthcare organizations to manage all of their financial and supply chain functions. *HIMSS17 TIP: Ask for Bill. He’ll explain how we’re blending operational efficiency and better decision making across the continuum. WE’RE ALSO CELEBRATING! Industry-leading research firm KLAS recently awarded Premier with FIVE prestigious Best in KLAS awards across five categories, including our first ERP award. SEE YOU AT HIMSS17! If you’re at HIMSS early in the week, we’re sponsoring the Pre-Conference Symposium on Population Care Management. Visit Premier at booth #5571 MONDAY – WEDNESDAY and enjoy a custom mixed soft drink from our specialty soda bar. While you’re with us, find out how the "right mix" of data, technology and services can get you on the road to success. AUTHOR INFORMATION
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_Chief operating officer, ITS at Premier, INC_
Leigh is a healthcare IT and supply chain leader who develops and executes procurement technologies and strategies within healthcare. When Lee isn’t working, you’ll find him reading Percy Jackson with his children and playing scrabble with his wife. Connect with Leigh on LinkedIn
In 2017, we know many changes in healthcare are coming. While there’s much uncertainty, there are a number of population health developments that we expect to see. * The speed of the transformation to VALUE-BASED CARE and payment models will continue to accelerate, while payment pressures on fee-for-service models grow. * MACRA to prevail and become both an economic opportunity, and threat to physicians and health systems. * An increase in the number of CONSUMER-DRIVEN HEALTH PLANS, and greater price and quality transparency, which will encourage consumers to be more price sensitive and involved in their personal health and healthcare decisions. * The Trump administration to stimulate growth of MEDICARE ADVANTAGE plans and expand similar “MEDICAID ADVANTAGE” models, and to potentially provide vouchers to Medicaid beneficiaries to purchase commercial Medicaid managed care policies. * More EMPLOYERS TO CONTRACT DIRECTLY with integrated delivery systems and clinically integrated networks to align incentives through shared savings arrangements and lower administrative costs. * CMS to release additional PHYSICIAN-LED MEDICARE PAYMENT MODELS (similar to CPC+) providing physicians and physician groups the opportunity to lead payment models and accept additional risks/rewards. * Continued growth in PHYSICIAN-OWNED and VENTURE CAPITAL-PHYSICIAN-OWNED healthcare services to create more price competition for outpatient services. * Demand for greater price and quality TRANSPARENCY to continue as consumers become more responsible for the first dollar and a greater percentage of their healthcare costs. * CONSOLIDATION of hospitals, physician groups, health systems, and population health entities to continue in order to expand market reach, and to build scale and efficiencies. * The AFFORDABLE CARE ACT to be “politically” repealed, however many key aspects will be retained, and either rebranded or privatized. * INFORMATION TECHNOLOGY opportunities to continue to improve in several areas, including for analyzing claims data and managing populations, patient communication, and remote and wearable monitoring services, all of which will enhance transparency. * Investments and research in PRECISION MEDICINE PROGRAMS to grow significantly to integrate genetic, clinical and claims information, and the social determinants of health into both predictive and personalized treatment models. To learn more about how Premier can help you, click here. Be sure to also check out Susan DeVore’s top five healthcare trends to expect in 2017. AUTHOR INFORMATION
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_Vice president, population health management at Premier, Inc._
I’m a population health expert who helps organizations manage the transformation to population health. When I’m not working, you’ll find me reading, playing golf, exercising and traveling. Connect with me on Twitter and LinkedIn.
CONSIDER THIS: If you are in a serious accident or have an illness that leaves you unable to talk about your wishes, who will speak for you? When it comes to important personal decisions regarding medical care for serious illness and eventual end-of-life care preferences, one conversation can make all the difference. ADVANCE CARE PLANNING (ACP) is the process that enables individuals to make plans about their future healthcare. Typically, advance care planning includes: * ACCESSING INFORMATION on the life-sustaining treatments that are available; * DECIDING WHICH TREATMENTS you want should you be diagnosed with a life-limiting illness; * SHARING YOUR PERSONAL VALUES and preferences with your loved ones; * ENSURING YOUR WISHES are documented in your health record; and * WRITING LEGAL INSTRUCTIONS (advanced directive) on treatments you would/would not want to receive. Advance care planning has not yet become a common practice, yet most people feel it should be. In fact, while 90 percent of people say that talking with loved ones about end-of-life care is important, only 27 percent have actually done so. And while most people—up to 80 percent—feel that sharing treatment wishes (should they become incapacitated) with their doctor is vital, only 7 percent report having had the conversation. Patients who have ACPs in place when they are needed report greater satisfaction with their healthcare and have been shown to have lower costs of care. There are excellent resources on advance care planning available both to patients/families and clinical care. One focused on ambulatory practices and other sites of care is the Institute for Healthcare Improvement’s program, “The Conversation Project.” At the QUEST National Meeting in December 2016, best-selling author Dr. Angelo Volandes also led a very popular presentation of his work with the non-profit ACP Decisions, which helps patients visualize the actual care decisions to be addressed. Fortunately, there is strong support for physicians, patients and family members to engage in end-of-life planning conversations. As of January 2016, the Centers for Medicare & Medicaid Services (CMS) pays for voluntary advance care planning under the Medicare Physician Fee Schedule (MPFS) and the Hospital Outpatient Prospective Payment System (OPPS). This has created appropriate incentives to promote spending time on these experience-enhancing discussions. Additionally, under CMS’ new Merit-based Incentive Payment System (MIPS), doctors and other clinicians must report on a certain number of quality measures successfully, and ACP leading to a plan of care for complex medical conditions can be an effective component of MIPS success. Most importantly, ACP enables Medicare beneficiaries to make important decisions that give them control over the type of care they receive and when they receive it, ultimately increasing patient satisfaction scores and overall physician performance metrics. Making the investment in advance care planning is beneficial, and will certainly pay off for physicians when reimbursement season rolls around. Even more importantly, the quality of care for many patients is sure to improve as a result. Interested in learning more about MIPS performance improvement services or the QUEST 2020 collaborative? Visit our website for more information. AUTHOR INFORMATION
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Dr. Madeleine Biondolillo is vice president, Quality and Safety at Premier, where she is responsible for growth of strategic quality and population health initiatives to support members in value-based healthcare delivery improvement. When shes not working, her hobbies are running half-marathons and volunteering in organizations that support victims of domestic violence.
In today’s value-based healthcare landscape, transparency, managing and evaluating patient outcomes, financial performance and operational efficiency is becoming more and more important. But keeping track of all the moving parts in various healthcare settings with numerous different processes can be quite a daunting task. So how do you provide the best possible mix of quality and affordability that ensures you’re delivering the highest quality care for patients at a cost they are willing to pay? AN EFFECTIVE VALUE ANALYSIS PROGRAM can help you thrive. Value analysis is a systematic, objective process that uses evidence-based and data-driven decisions to ensure physicians and clinicians have access to quality products at the right time and at the right price. These programs can help to manage the process for obtaining quality supplies, services and equipment, and ensures their availability at the lowest total cost to support quality patient care. THE VALUE ANALYSIS PROCESS Successful value analysis programs are structured in a way that follow and adhere to the organization’s processes and supports the health system’s mission, vision and strategic goals. In addition, these programs must also have a strong framework built around quality and safety and focus on the appropriate utilization of supplies and services. Value analysis helps to properly vet products and services used in our facilities, especially new technology, and demands an evidence-based, structured and rational approach that includes all key stakeholders in the decision-making process. These processes provide the structure that healthcare organizations will need to face the challenges of an ever-changing healthcare landscape. To learn more about the value analysis process and best practices that can help enrich your program, download our Value Analysis Guidebook. AUTHOR INFORMATION
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_Senior director, comparative effectiveness at Premier, Inc._
As the senior director of comparative effectiveness, I help to bring healthcare organizations together to share information and improve performance.
As Congress and the Trump Administration move full-steam ahead on a new health policy agenda, there’s relief in knowing that not every aspect of healthcare is a politically contentious issue. Take the movement toward value-based care. New delivery models that incent providers to clinically integrate and assume accountability for delivering the best outcomes for their patient populations has broad support. It is likely to accelerate in the years ahead - with full backing from both sides of the aisle. Need proof? * MACRA, which moves physicians into the world of alternative payment and value-base care, was passed by a Republican-controlled Congress with overwhelming bipartisan support and signed by President Obama. Meaning that both Republicans and Democrats have a vested interest in seeing value-based, pay-for-performance payments succeed. * Significant investments have been made in these models already, and they are starting to bear the predicted fruit. There are now well north of 800 private and public accountable care organizations (ACOs) nationwide, and about 30 percent of all Medicare and Medicaid provider reimbursements are flowing through an alternative payment model. Just in the Medicare program, which includes more than half of all ACOs, participants have generated $1.29 billion in Medicare savings since 2012, while improving quality. Premier’s experience with our ACO collaborative has been even better, making up just six percent of ACOs in the program, yet generating 20 percent of the savings. * Value-based care and alternative payments are the only anecdotes to perpetual cuts to fee-for service (which we can most definitely expect), as well as rising costs for medical devices and drugs. In today’s environment, discounts and price concessions are simply not enough to make the expense math work – the only solution is to improve population health to avoid unjustified utilization entirely. And the only way to earn revenues for that preventive work is through alternative payment. While we know these models are working, there’s still room for improvement. Today, Premier, along with leading organizations representing clinicians, employers, labor, hospitals, pharmacists, consumer groups and insurance carriers across the country, released policy principles that should be addressed to ensure that the movement toward value-based care continues and that models are fixed to attract additional providers. RE-ENGAGE As a core principle, we must empower and engage patients to make healthcare decisions with information and support from their healthcare team. RE-EVALUATE There are hundreds of different measures included in overlapping value-based care models. As we move forward, we need a common set of measures used across all public and private programs, and they need to assess performance in a way that is meaningful and actionable by consumers. RETOOL While provider access to beneficiary data is improving, we should revisit this issue to ensure that information is more complete, timely and accurate to better facilitate care management and proactive provider interventions. REINVEST More models are being developed all the time, but we need a concerted effort in evidence-based testing of new alternative payment models so that providers, payers and patients can learn how they work in the real-world and how they should evolve in future clinical settings. It’s also imperative to test the incentive structure so that we know what works and what doesn’t in terms of the ROI, and how those incentives affect patient care. REBALANCE Participants in alternative payment do have the ability to qualify for legal waivers that can stand in the way of collaboration and shared accountability, but while programs are being retooled, Congress should take a look at expanding these to all ACOs, not just those participating in Medicare programs. We should also allow additional waivers for participants to offer beneficiary engagement tools such as co-pay waivers or transportation vouchers. We stand prepared to work vigorously with the Administration and Congress to expand upon the quality and cost savings progress made in America, and we look forward to taking the next steps to reach and surpass the tipping point where value-based healthcare becomes a sustainable marketplace for generations of Americans to come. To drive forward the value-based care movement, CLICK HERE. AUTHOR INFORMATION
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We all see it coming: the repeal and replacement of the Affordable Care Act - a key position for Donald Trump during his presidential campaign. With his impending inauguration just two weeks away, we now have an opportunity to rethink healthcare. As policy changes are considered, one thing that both parties can agree on is the continued need to improve quality, reduce costs and build on existing successes, such as the move toward a value-based care delivery and payment system. Here are three focus areas for the Trump Administration that will help capitalize on the gains we’ve already achieved. 1. CREATING INCENTIVES FOR DELIVERY SYSTEM CHANGES The Medicare Access and Chip Reauthorization Act (MACRA) has clear incentives for providers to move toward value-based care and alternative payment models. However, current models need some work to better balance risks and rewards, and clear away any legal and regulatory barriers that can discourage participation. For providers to succeed, key policy changes are needed, including: * CHOICES AND FLEXIBILITY AMONG THE ALTERNATIVE PAYMENT MODELS – Healthcare providers need additional options and greater incentives to participate in value-based payment models, such as accountable care organizations (ACOs) and bundled payments. * PRESERVING AN INFRASTRUCTURE FOR INNOVATION – It’s difficult moving away from the antiquated and broken fee-for-service system on which our healthcare system is built. Healthcare providers and clinicians are accustomed to it, but its payer-led model undermines healthcare provider innovation and accountability. We need a means to learn our way to a new model, which requires an infrastructure to innovate and voluntarily testing of new care models that can be scaled nationally. * STATE FLEXIBILITY TO ASSIST PROVIDERS TO MEASURABLY IMPROVE QUALITY AND REDUCE COSTS – States should be able to implement innovative payment and delivery models that will lead to better coordination, reduced costs and improved care. * INFORMING CONSUMERS – Consumer engagement is key to MACRA’s success and can be improved by increasing transparency of quality and cost information and providing flexibility around benefits to incent the right behaviors. 2. EMPOWERING PROVIDERS AND CONSUMERS WITH GREATER ACCESS TO HEALTHCARE DATA AND INTEROPERABLE TECHNOLOGY Successful quality improvement by healthcare providers and a more empowered consumer requires effective use of clinical, pricing and other data, as well as patient access to their own medical information through interoperable, secure information systems. Patient data should be able to be accessed closer to real-time to help providers improve quality, and electronic health records should move from being closed systems to interoperable medical records that make it easy for providers and patients to exchange information. 3. BRINGING DOWN COSTS THROUGH PHARMACEUTICAL COMPETITION A greater federal focus is needed to create a more competitive market for pharmaceuticals. As Susan DeVore recently discussed in Modern Healthcare, we need to implement solutions that will drive competition and keep costs down, including: * Faster approvals from the FDA; * More biosimilar approvals; * Ending pay-for-delay; and * Relaxation of closed distribution networks. We recently shared these suggestions in a letter to the Trump Administration, along with our Delivery System Transformation Roadmap which provides a more detailed account of our recommendations. We look forward to being able to continue to partner with our members and Washington to transform care delivery and improve America’s healthcare system. To learn more about Premier’s advocacy efforts, CLICK HERE. AUTHOR INFORMATION
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The list of possible challenges that could arise during the life cycle of a medical construction project are as varied as the projects themselves. However, some of the most common challenges revolve around structuring and assembling the right project team and deciding whether or not an equipment planner is needed. ASSEMBLING THE RIGHT TEAM Creating the ideal integrated project team can present challenges early on in a medical construction project. To avoid any drama or confusion on day one, make sure that all the necessary stakeholders are brought together at the very early stages of the project. You should aim to have most, if not all, key stakeholders should be involved even as the project is just being designed.. This will help with cohesion and consistency, but also helps ensure details won’t be overlooked or missed in the later stages of the project. EQUIPMENT PLANNERS Deciding whether or not to engage an equipment planner is often a decision that is disregarded in the early stages of a construction project. Ask yourself these three questions when making decisions in terms of equipment planning: * Is there already someone on the project team that can plan for all of the medical equipment needed for this project? * Does that person have the necessary experience with medical equipment planning to ensure for the project’s successful outfitting, including a thorough understanding of the RFP process for vendors? * Does that person have other project responsibilities that they will be pulled away from to do the equipment planning, or that might prevent them from devoting the necessary attention to the medical equipment planning? All too often the discussion about the need for an equipment planner arises well into the life of the project; sometimes, too late for an equipment planner to be effective. It’s best to engage an equipment planner as early as possible during a construction project as a means to properly estimate and plan for what supplies are needed, how much will be needed and what equipment will be deliver on quality but also be cost-effective. In addition, the equipment planner can work with supply chain personnel and end-users to effectively plan to reduce the likelihood of costly change orders in the later stages of the project. By keeping the equipment planner engaged throughout the lifecycle of the project, the equipment list can be effectively managed, and kept up-to-date, reducing the need to overhaul equipment purchasing process as the project enters the later stages. To learn about how Premier can help with your construction projects, click here. AUTHOR INFORMATION
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_Director-Equipment Planning & Technology Services at MEMdata, Premier Inc._
Director-Equipment Planning & Technology Services
From precision medicine to “smart pills” with embedded chips, there is no shortage of new innovations in the pharmacy market. One of the most interesting new developments is biosimilar medications. But what is a biosimilar and how does it work? I address these questions and more in my new e-book, _Biosimilars 101: Facts, Risks and Opportunities._ Here is a sneak peek: * WHAT ARE BIOSIMILARS? * WHAT ARE SOME CHALLENGES WITH BIOSIMILARS? * ARE BIOSIMILARS A SAFE ALTERNATIVE FOR PATIENTS? * SHOULD PROVIDERS BE PRESCRIBING BIOSIMILARS? * IS THERE A FEDERAL APPROVAL PROCESS FOR BIOSIMILARS? * WHAT DOES THE FUTURE LOOK LIKE FOR BIOSIMILARS? How are biosimilars cutting costs, creating competition and ultimately driving pharmacy innovation? Download the free e-book to learn more. AUTHOR INFORMATION
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I am a practicing physician who is the chief medical officer of Premiers Specialty Pharmacy team. When I am not working, you can see me on the trails with my bicycle or spending time with my daughter. Connect with me on LinkedIn to learn more.