Neurology is at a turning level. After a long time of restricted progress, new disease-modifying remedies (DMTs) for neurodegenerative circumstances like Alzheimer’s and plenty of others are lastly reaching the market. Whereas some nonetheless query the scientific advantages and security dangers of DMTs, new Alzheimer’s therapies from Biogen (Leqembi) and Eli Lilly (Kisunla) are simply two examples of long-awaited scientific breakthroughs.
But, with new therapies being accepted, and plenty of others within the pipeline, we face a important query: Is our healthcare system ready to ship them successfully and sustainably?
Proper now, the reply isn’t any. However that hole represents a significant alternative for innovation. We’re approaching a novel convergence level the place neurology will grow to be top-of-mind throughout the healthcare ecosystem, requiring daring new approaches in how we ship and pay for care.
Care supply: The unmet alternative for orchestration
The rising availability of neurodegenerative DMTs creates a possibility for well being programs to enhance the economics of a excessive precedence however low margin neurology service line historically buoyed by procedural quantity. These therapies demand seamless, end-to-end operational and scientific workflows to correctly determine eligible sufferers, present training, ship therapeutics, measure remedy efficacy, and monitor uncomfortable side effects.
Leqembi and Kisunla are each administered by way of infusion, so hospital-pharmacy collaboration and infusion clinic capability are key necessities to ship remedy. Frequent imaging can also be important to watch for security occasions and modify remedy. This requires imaging availability and acceptable triage based mostly on outcomes. Lastly, if a affected person seeks emergency take care of uncomfortable side effects whereas on remedy, ED pathways should be configured to route these sufferers accordingly.
The administration and monitoring of those therapies require new entry factors and a excessive diploma of cross-department collaboration. The healthcare system at present lacks a coordinated infrastructure and orchestration layer, leading to gaps that hinder the supply of probably life-changing remedies and the suitable administration of significant dangers for these present process remedy. The chance for innovation and partnership on this house is ripe for sturdy fashions that combine present workflows with the supply of those new therapies.
Fee: The necessity for sustainability
The promise of DMTs is super, but it surely comes at a value. Traditionally, payers have seen neurology as a comparatively low-priority situation set. Most have appeared to enhance gaps in neurology entry versus addressing neurology as a class of spend. Nevertheless, Leqembi is estimated to value as a lot as $26K yearly – and that’s earlier than any follow-up care, testing, or monitoring. Specialty therapeutic spend will introduce extra margin pressures for payers and reinforce the necessity for extra sustainable methods to pay for neurodegenerative care.
Some look to the CMS GUIDE mannequin, which is tailor-made to Medicare beneficiaries with dementia, as a sign for fee mannequin innovation. Whereas GUIDE is a way to coordinated, collaborative care that may enhance outcomes and decrease avoidable, high-cost providers, it’s not a real on-ramp to value-based care (VBC) in neurology. GUIDE has no express, quantified value financial savings targets, and even strategies for measurement.
VBC in neurology faces unimaginable complexity with the attribution of value financial savings, much more so than different specialty VBC fashions. One motive is as a result of sufferers with a neurodegenerative situation are not often admitted to the ED or hospital with a neurological analysis. For instance, a affected person with dementia and worsening cognitive decline might expertise an unexplained fall or damage, acute an infection, or persistent illness issues. Although the result and underlying dementia analysis are inextricably linked, when this affected person presents to the ED, they are going to understandably be admitted for the acute situation, not dementia.
Whereas VBC in neurology is difficult, it’s not unsolvable. Actually, extra formalized care pathways and DMTs create the chance for neurology VBC suppliers and enablers to be extra pointed within the worth they drive. Worth could be derived from proactively and appropriately figuring out eligible sufferers for remedy, optimizing for expensive monitoring and imaging necessities, and upskilling and leveraging different care workforce members for much less advanced circumstances. These levers not solely save downstream prices but in addition help a capability constrained workforce.
The trail ahead for neurology care and fee
The supply of recent therapeutics represents a possibility for well being programs to enhance the economics of their neurology service line. But the market lacks infrastructure and enablement layers to help the brand new workflows required. This consists of addressing the diagnostic bottleneck, figuring out and triaging eligible sufferers, and managing ongoing care and follow-up. Elevated demand and the silver tsunami will amplify stress on neurology to higher leverage superior observe suppliers. And lastly, these fashions needs to be able to adapt because the tempo of innovation will increase. For instance, improved biomarkers may finally reduce the necessity for imaging and new drug formulations.
As for constructing extra sustainable fee fashions, just a few extra dominoes must fall to ripen the marketplace for innovation. Extra accepted DMTs should come to market, rising prices for payers and forcing them to intensify their focus. Care pathways should proceed to mature, bringing extra certainty to outcomes and not using a lengthy and dear care odyssey. Lastly, bigger platforms might want to carry a really fragmented market of neurologists collectively, creating house to check and scale risk-sharing preparations that particular person practices couldn’t handle alone.
With new options (or remedies) come new challenges. However new challenges create new alternatives. Innovators and entrepreneurs who’re constructing on the momentum going down in neurology proper now, and making ready to scale their choices, will likely be able to rework neurology and the lives of a very powerful stakeholders: sufferers and their caregivers.
Photograph: Khanisorn Chaokla, Getty Pictures
Adeyoola “Yoola” Adeniji brings expertise from each the healthcare supplier and digital well being startup world to LRVHealth’s funding workforce. She labored in operations at Cohere Well being, a digital well being startup automating administrative transactions inside healthcare, and held roles at Mass Basic Brigham (previously Companions Healthcare), the place she co-led digital well being document implementation and coaching for inhabitants well being applications and first care practices. As an affiliate at LRVHealth, Yoola helps supply and help all features of the agency’s investments, from due diligence by way of execution. Yoola earned her MBA at Yale College of Administration, the place she was the category commencement speaker, in addition to a Consortium Fellow and Forté Fellow. She graduated summa cum laude from the College of Florida with a B.S. in Well being Schooling and minor in Communication Research.
This put up seems by way of the MedCity Influencers program. Anybody can publish their perspective on enterprise and innovation in healthcare on MedCity Information by way of MedCity Influencers. Click on right here to learn how.
