27. Ken Thorpe, Chairman of the Partnership to Fight Chronic Disease

Published June 16, 2021

Listen and subscribe to This is Growing Old, a podcast from the Alliance for Aging Research

Show Notes

Alliance for Aging Research President and CEO Sue Peschin interviews Ken Thorpe, the Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management in the Rollins School of Public Health of Emory University, and Chair of the Partnership to Fight Chronic Disease, an organization that does incredible work to raise awareness of the impact of chronic disease on death, disability, and rising healthcare costs.

Episode Transcript

Sue Peschin:

Hi, everyone. And welcome to the Alliance for Aging Research’s podcast: This is Growing Old. I’m your host, Sue Peschin, and I serve as president and CEO of the Alliance for Aging Research.

Sue Peschin:

Before we get started on today’s topic, I wanted to share that we have now been doing this podcast for over a year. It’s been incredibly inspiring to talk with so many people who are making a difference in the lives of older adults. I sincerely hope you’ve enjoyed listening to our conversations.

Sue Peschin:

I also really want to give a shout-out to Janelle Germanos. She’s our communications manager at the Alliance for Aging Research. She generated this idea, got it started, produces, makes everything smooth and just wanted to thank her so much for starting this.

Sue Peschin:

The guests on the podcast come from all walks of life, but they have one thing in common: We’re all getting older together, and we want it to be a better experience for everyone. Our guests are true change makers, and today’s guest is no exception to that.

Sue Peschin:

I’m here with Dr. Ken Thorpe, the Robert W. Woodruff Professor and chair of the Department of Health Policy and Management in the Rollins School of Public Health at Emory University. Dr. Thorpe is also the chair of the Partnership to Fight Chronic Disease, an organization that does incredible work to raise awareness of the impact of chronic disease on death, disability, and rising healthcare costs. The Alliance for Aging Research is honored to be a member of PFCD.

Sue Peschin:

Ken, thank you so much for joining us today. You are the chairman of the Partnership to Fight Chronic Disease as I just mentioned, also known as PFCD for short. Can you please tell our listeners a little bit more about the mission of PFCD?

Ken Thorpe:

We’ll, sure. We’re, have been around for over a decade now. We’re a coalition of organizations that include patient advocacy groups, health plans, different types of healthcare providers, business groups, labor groups.

Ken Thorpe:

We’ve all come together in a really non-partisan basis to highlight the critical role that the rising prevalence of chronic disease plays in not only being the main driver of rising healthcare costs, but also the single largest source of morbidity and mortality in this country.

Ken Thorpe:

So we spend a lot of time bringing data and facts to bear to policymakers. We work at the state, national and international level. We have focused on interventions that do a better job of preventing the growth in chronic disease, finding ways to earlier detect chronic illness, and then looking at different types of models of care that do a better job of engaging and working with patients that have multiple chronic conditions to keep them healthy.

Ken Thorpe:

So we collaborate frequently across the aisles. We’ve, I think, had a lot of success in putting forth legislation that really accomplishes and deals with all three of those issues.

Sue Peschin:

You certainly have. It’s really, to me, it’s one of the most effective coalitions that we’re proud to be a part of. So thank you for your leadership and all the work you’ve been doing over these years.

Ken Thorpe:

Well, thanks. And thanks for your contribution to it.

Sue Peschin:

Absolutely. PFCD recently released a white paper that caught our eye. We were very excited about it, with Dr. Douglas Holtz-Eakin. He’s president of the American Action Forum, and he’s also a former director of the Congressional Budget Office. This white paper focused on the FDA’s accelerated approval pathway. I want to get into what the paper looked at. But first, would you explain what the accelerated approval pathway is?

Ken Thorpe:

Well, sure. The FDA, the Food and Drug Administration, instituted this accelerated approval program back in 1992 to allow for faster and earlier approval of drugs that treat serious conditions, that fill an unmet medical need based on different types of what are called “surrogate end points.”

Ken Thorpe:

It really came to be in the time of HIV/AIDS where there really weren’t effective treatments available. As the surrogate end point, they use your immune cell response to different types of drugs.

Ken Thorpe:

It was a way to rapidly expand the access and availability to medications, in this case HIV/AIDS, to treat conditions where there really were no treatments on the market. So it’s been a very valuable tool for very serious and rare healthcare conditions.

Sue Peschin:

Yeah. So tell us about the paper that you co-authored. I know the Medicaid and CHIP Payment and Access Commission recently voted on some recommendations, and I want to hear about the implications for patients and how your paper tried to address some of the concerns that were behind that vote.

Ken Thorpe:

Well, yeah. We started to look into this because we were hearing from a couple of states that they had concerns over some of these medications and treatments, that they were essentially breaking the bank, that they were a major part of the growth in Medicaid spending.

Ken Thorpe:

So we took a look at this in terms of the last 15 years or so of how much of the growth in Medicaid spending was really linked to expenditures on these accelerated medications and drugs? What we found was that really they only account for about one to one-and-a-half percent of the growth in Medicaid spending.

Ken Thorpe:

I mean, it’s really has nothing to do with what’s driving the underlying growth in Medicaid spending, or really what accounts for the high level of spending on the Medicaid program. I mean, those high levels expenditures are really linked to patients that are really seriously ill.

Ken Thorpe:

We call them dual eligibles that are Medicare and Medicaid patients that have all kinds of different types of disabilities that have a very, very high healthcare costs. So we wanted to engage a discussion to say, “Well, if we’re serious about slowing the growth of Medicaid spending, let’s really look at what’s driving the growth in the first place.” And it really has nothing to do with accelerated approval drugs.

Ken Thorpe:

If we’re really going to deal with the high cost of Medicaid, we might want to look at what can we do to do a better job of working with these very sick, chronically ill dual-eligible patients that have a very complicated financing scheme that includes both Medicare and Medicaid. So how can we do a better job of streamlining those payments, integrating the programs, doing care coordination across both programs?

Ken Thorpe:

That really is the direction that we’re focusing on is highlighting where the drivers are and where the real opportunities are. There’s a lot of opportunities there. And rethink the delivery model for dual eligibles in the Medicare/Medicaid program.

Sue Peschin:

So tell us a little bit about what this Medicaid commission recently voted on around the accelerated approval program drugs and maybe why they did it and what you think some of the implications could be.

Ken Thorpe:

Well, yeah. They were voting on the ability to give states the flexibility in not including some of these medications as part of their formularies. That’s a real problem because by the definition of the program, these types of medications are really filling a completely unmet need. So in essence, by giving states the opportunity to not cover them, you’re really taking away maybe the only treatment option for some types of patients in terms of managing their condition.

Ken Thorpe:

So again, it was to me an unfortunate vote. It really misses the boat in terms of really trying to focus on slowing the growth of Medicaid spending because this is not a program that has anything to do with that.

Ken Thorpe:

We’re continuing our efforts to really focus attention on what opportunities do we have to work with states to slow the growth of Medicaid spending, make it more efficient and more effective. But unfortunately, taking treatment options away from patients that have no other options is really not one of those.

Sue Peschin:

Right, right. Do you think that Congress is going to act on this recommendation, and do you think it’ll gain momentum in the Medicare program as well?

Ken Thorpe:

Well, we certainly hope not. I think as part of what we do, we spend a lot of time thinking about how can we make these federal programs more effective and more efficient rather than cutting out treatments. So rationing access to essential medications to me is really not a viable policy option, and we’re hoping the Congress certainly does not take those recommendations from the Commission.

Ken Thorpe:

Instead, we’ve been looking at finding opportunities to continue to migrate away from fee-for-service payments, building models that better integrate care between hospital, post-acute and home care and telehealth care to really focus on the whole person care rather than sort of these different silos that we’ve been focusing on in the past. So there are good models out there that we can spend time on that will make both Medicare and Medicaid more efficient and more effective and produce better outcomes.

Sue Peschin:

So in recent legislation, there was a vast expansion of the Medicaid waiver program for states to be able to use it more for home and community-based services. What do you think about that? Is that something that you’re supportive of? What do you want to see come out of that?

Ken Thorpe:

Well, again, there are some good models that we’ve seen, the independence-at-home types of models that came out of Baltimore some years ago. Those are models that seem to be very effective.

Ken Thorpe:

By moving patients out of an institutional setting and providing evidence-based care for them at home, oftentimes using remote patient monitoring, using tele-health, I think those are innovative delivery models that we need to take a closer look at.

Ken Thorpe:

They’ll save money, and certainly from that, from an individual patient standpoint, getting treated at home is certainly going to be a more pleasurable experience than being treated in a hospital or in other types of an institutional setting.

Sue Peschin:

Right, right. And also to your point, I mean, it’s not a new idea, but the work that you’re doing to try to raise awareness of better coordination between the Medicare and Medicaid programs is really critical. I mean, it’s been recommended by the Medicare Advisory Commission for years, and for some reason that nut has not been cracked yet. What do you think it’s going to take to solve that issue?

Ken Thorpe:

Well, again, I think we need to have more focus perhaps from the CMS to continue to identify evidence-based models that work. I mean, the challenge you have in the dual eligible population is that oftentimes you’ll have a Medicare plan that work with the patient, a Medicaid plan working with the patient, perhaps even a separate prescription drug benefit. And that’s not good collaborative care.

Ken Thorpe:

So what we need to do is come up with models that really integrate those three functions under one umbrella to provide integrated coordinated care across these two programs. I think that there are some models that we’ve worked on using health teams, increasing use of some telehealth opportunities.

Ken Thorpe:

There’s just incredible innovations going on now in remote patient monitoring, that we can really keep track of these patients in terms of their vitals to prevent them from getting to the point where they end up in an emergency room or a hospital. So I think the focus is on delivery system innovations, and this is a great population to really spend time on.

Sue Peschin:

That’s great. Terrific. Well, are there other PFCD initiatives that our listeners should know about?

Ken Thorpe:

Well, we have sort of a related group, the Partnership to Fight Infectious Disease, that we’ve just started as well. This is a coalition that’s really focusing on trying to develop innovation and develop the new drugs to deal with antibiotic-resistant infections. I think we’ve seen some good models of how we can spur innovation in that market.

Ken Thorpe:

Those infections have doubled over the last decade. If we don’t do something about them, it really compromises our ability to do just basic surgery and surgical procedures if we’re going to have a continued rise in those types of infections.

Ken Thorpe:

So we’ve been working on promoting legislation that would provide a model to basically pre-fund the research, to provide incentives for the drug companies to come in and innovate. The problem is as big as it is, it’s still relatively small, and the return on investment is quite low.

Ken Thorpe:

I think the model that we’ve seen here with the COVID-19 approach, where the government came out and basically made a commitment to purchase hundreds of millions of doses, had a streamlining in the clinical trial process, is a potentially good model. So we’ve been working on, backed in the Senate, called the PASTEUR Act, which kind of does that. It does a subscription-based model and provides upfront funding.

Ken Thorpe:

So we continue to focus on innovations and treatments around not only chronic disease, but innovations in improving patients’ health. And this is a new area that we just recently engaged in.

Sue Peschin:

Yes, and thank you. Fabulous that you’re doing that. We’ve been involved in those issues for a long time because it’s critical for older people. They’re the most likely to have antibiotic-resistant infections, so really grateful to you that you’re doing that work and the work on the PASTEUR Act. So thank you.

Sue Peschin:

Here’s a question we ask all of our guests. When you were a kid, what did you imagine growing older would be like?

Ken Thorpe:

Well, that’s a tough one, I mean, because the models I’ve had obviously are my parents and grandparents, and so I sort of envisioned that. Fortunately for me, when I was smaller, my parents and my grandparents were very, very active.

Ken Thorpe:

They were in relatively good health. They looked a little different than me, but other than that, I envisioned sort of just an older looking Ken, but somebody who’s just very active, very intellectually curious, still loves to travel. So fortunately for me, I had some really good role models in terms of parents and grandparents about the aging process.

Sue Peschin:

That’s awesome. Well, so what do you enjoy most about growing older now?

Ken Thorpe:

Well, I mean, it brings on different types of challenges and opportunities. I think some of it is just developing a better reflection on society, a better reflection on individuals. A little bit more wisdom, perhaps. A little bit more patience in terms of how I deal with things.

Ken Thorpe:

But for me at this point, the opportunities in terms of what I want to work on and what I want to do really haven’t slowed down. So I haven’t hit an inflection point yet in terms of things I’m working on and things that I’m doing. But certainly it provides an opportunity to look back and reflect on the past and really understand the importance of the relationships I’ve had and family and so on.

Sue Peschin:

That’s great. It seems like connection is a big theme for you and staying active, certainly. Well, Ken, thank you so much for joining us today. I really appreciate it.

Ken Thorpe:

Well, thanks for having me on. I really enjoyed it, and it’s always fun to see you and work with the Alliance.

Sue Peschin:

You too. Thanks everyone for listening to This is Growing Old. Our intro and outro music is City Sunshine by Kevin MacLeod. Please stay tuned for new episodes every other Wednesday.

Sue Peschin:

As always, you can subscribe on Apple Podcasts, Google podcasts, Spotify or anywhere else you listen to podcasts. Please rate and review us if you’re enjoying the show. Thank you so much for listening to This is Growing Old and have a great day.