Boris Vabson

CMS Senior Advisor (views my own)

[Boris Vabson @borisvabson]

I have a new paper in JAMA with Ben Ippolito and colleagues, looking at how frequently patients run into formulary or UM issues when attempting pick up at a pharmacy, and what follows when a patient is initially rejected! Study enabled by unique, point of sale data from pharmacies!

[Ben Ippolito @ben_ippolito]

We have a new paper in @JAMA_current documenting the now-ubiquitous nature of formulary management for brand drugs

By 2024, 40% (!) of initial attempts to fill a brand drug were rejected for prior auth or formulary exclusion (most of the growth over time is more prior auth)

[Paragon Health Institute @Paragon_Inst]

Welcome to the Paragon team, @borisvabson!

[Brian Blase @brian_blase]

We are fortunate to add you to the Paragon team, Boris! You do outstanding research, have keen insights, and want to improve health policy. Welcome!

[Boris Vabson @borisvabson]

@brian_blase Thank you Brian! Thrilled to be on board!!

[Boris Vabson @borisvabson]

Excited, honored, and humbled to be on board!

[Paragon Health Institute @Paragon_Inst]

Welcome to the Team, Boris!

[Boris Vabson @borisvabson]

As for me, I'll be joining @Paragon_Inst, and from that perch will continue to remain active in Medicare policy! I will also be taking on some additional commitments (stay tuned!) I'm grateful to my wife Lucy for making the move from NYC to DC with me, and for being accepting of the sacrifice that comes with service! Looking forward to taking an overdue break this summer and going traveling with our 8 month old son and our 2 year old Bernedoodle!

[Boris Vabson @borisvabson]

Last month, I wrapped up my service at @CMSGov! It's been a pleasure and a privilege to oversee @CMSInnovates's MA efforts, and to support the agency's broader MA strategy.

[Boris Vabson @borisvabson]

I'm proud of the important MA work that the CMMI team has undertaken over the past year. This work positions CMMI to play a leading role in MA, not just for the near term but also the long term! I'm excited to see all the ways that CMMI can and will make the program better, thanks to its unique testing authority, waiver authority, and especially the incredible CMMI team behind it! Stay tuned!

[Boris Vabson @borisvabson]

@ben_ippolito And as our paper finds, the effect of prior auth is sizable: a 25 percent utilization reduction! Even though this effect is largely through deterrence, clearly deterrence works!

[Boris Vabson @borisvabson]

This RFI is a joint effort between the Innovation Center and the Center for Medicare. The RFI reflects the agency’s resolve to improve and modernize the MA program, through multiple channels including CM rulemaking and new CMMI models. It’s been an honor and a pleasure to develop this RFI alongside my CM and CMMI colleagues, and with the indispensable support of Administrator Oz and CMS leadership.

[Boris Vabson @borisvabson]

Today, CMS released an RFI around future policy directions in Medicare Advantage, focusing on opportunities for maximizing competition within the program, driving improvements in health outcomes, and maximizing the program’s value for beneficiaries and taxpayers. https://t.co/nzcQOAZSRA

[Boris Vabson @borisvabson]

Some personal news!

[Antonio García Martínez (agm.eth) @antoniogm]

Before shabbat starts on what's hopefully the last shabbat of the war, let me share some thoughts on why this war has ground on as long as it has, or why Israel has refused any ceasefire that did not include a total release of the hostages.

The central narrative of the Hebrew bible is the flight from Egypt, from slavery and oppression, to freedom in one's own land. In the Amidah prayer, the central prayer of Jewish worship, one praises God for 'releasing the bound'. The Shulchan Aruch, the core text of Jewish law, states "There is no mitzvah greater than redeeming captives."

In more recent history, the Jewish state pulled off miraculous logistical feats like evacuating thousands of Ethiopian and Yemeni Jews from under their oppressors' noses.

Even more recently, I saw with my own eyes how in Ukraine, within days of the war starting, Israel dispatched a team to exfiltrate tens of thousands of Jews in the midst of a chaotic invasion. These weren't even Israelis, they were just Ukrainian Jews caught in the crossfire, but the Jewish state would not abandon them to their fate.

The entire purpose of the Jewish state is to forever prevent Jews anywhere from ever living in fear or persecution again. Few non-Israelis seem to understand this; more would understand the state's actions if they did.

If the Hamas that so stupidly started this war also chooses to renege on the deal and stupidly continue it, then the Israeli war machine will once again rumble awake, for Israel will never abandon Jews scared and starving in tunnels a few kilometers from its borders. The IDF has already suffered more deaths in this war than hostages remaining, but that cold calculation is irrelevant here: There is no mitzvah greater than redeeming captives.

Whatever the wider world--the 'international community,' the UN, X, the 'globalize the intifada' crowd--thinks about these values is irrelevant. Jews see themselves as the protagonists of their own 3,000-year-old story; a thousand years from now, Jews will still be singing, in triumph and tragedy, about the events today, while all these other players will have disappeared into oblivion.

Let's hope the hostages are returned in the 72 hours that Hamas has to hold up their end of the bargain, and that Simchat Torah next week (when Jews celebrate the founding text of their culture) will be a joyful one, unlike the horrifying one of two years ago.

שבת שלום

[Boris Vabson @borisvabson]

Some personal news!

[AEI Economics @AEIecon]

How much of total patient cost-sharing is paid upfront? How does it break down across different insurance types?

@Ben_Ippolito and @borisvabson explore these questions in a new @AEI Economic Perspectives report:

https://t.co/rT0J9BxCYB

[Michael R. Strain @MichaelRStrain]

.@ben_ippolito & @borisvabson: "The characteristics of patient cost sharing can have important implications for health care markets.1 While researchers and policymakers have focused heavily on changes in the level of cost sharing over time, the structure and timing of those payments are also important factors for access to care and patients’ and health care providers’ financial outcomes."

[Boris Vabson @borisvabson]

4. Given the aforementioned significant benefits of pre-service payments, there is still the potential for their much wider future adoption. This could happen through changes by insurers (increased use of copays over coinsurance) or through changes by providers (increased requirement for deposits)

[Boris Vabson @borisvabson]

In previous research, we documented patient medical bill repayment rates of under 50 percent, and falling. Such low repayment rates could be partly attributable to the longstanding timing of billing: taking place weeks after a service is performed, with provision of the service therefore not being at all contingent on payment!

In this recently released paper, we look at whether this longstanding convention may be changing, and whether patients are increasingly being required to make pre-service payments.

[Ben Ippolito @ben_ippolito]

Cost sharing is frequently unpaid, providing a reason to encourage/require upfront payments.

In a new paper, @borisvabson and I show that these upfront payments account for a meaningful fraction of all cost sharing that is paid--around 15 or 20% depending on payer.

[Boris Vabson @borisvabson]

3. Increased use of prepayments could not only boost patient bill repayment rates, but also have other benefits, such as encouraging price shopping by consumers, creating markets in healthcare, and making cost sharing into a more effective mechanism with which insurers can steer care.