Dr. Richard Stefanacci
Chief Medical Director
Expertise:
Richard has focused his career on improving health outcomes, especially for some of the most vulnerable populations. This has been achieved through several avenues, beginning with his continued active role as a treating internist/geriatrician. He has also put this focus into practice as chief medical officer for several management care plans, including ElderHealth/Bravo/HealthSpring/Cigna and PACE (Program for All-inclusive Care for the Elderly) programs, as well as his current role as a pharmacy and therapeutics committee member for several national plans. On the policy side, Richard served as health policy scholar for the Centers for Medicare & Medicaid Services (CMS) through his role at Thomas Jefferson University, College of Population Health, where he maintains a faculty appointment. He has over 500 publications in addition to delivering well over 1,000 lectures, both nationally and internationally, focused on improving health outcomes. Today, Richard is actively engaged in leading population health activities for numerous health systems and payer groups.
His recognized expertise has led to Richard being appointed to serve on the American Society of Consultant Pharmacists (ASCP) and the AMDA Foundation boards, as well as being an honorary lifetime member of the ASCP and the National Association of Directors of Nursing. Richard has achieved recognition as a fellow in both the College of Physicians of Philadelphia and the American Geriatric Society and was recently awarded the Humanism in Aging Leadership Award from the University of New England.
Richard’s work for vulnerable populations is very personal, stemming from his involvement with the Go4theGoal Foundation (www.Go4theGoal.org), a 501(c)(3) public charity that he founded with his family and friends when his oldest son, Richard, was diagnosed with Ewing’s sarcoma. Since its inception, the foundation has raised several million dollars to assist hundreds of children affected by cancer at nearly 100 children’s hospitals across the country while also funding cutting-edge research to find a cure. This research work is directed by the foundation’s panel of experts, which includes several current and past federal government leaders in rare diseases.
Richard holds a DO and an MS in geriatric healthcare from the A.T. Still University of Health Sciences, as well as an MBA from the Keller Graduate School of Management of DeVry University. He is also an American Geriatrics Society Fellow and a certified medical dosimetrist.
Articles by Dr. Richard Stefanacci
BLOG: Segmenting Health Systems
The COVID-19 pandemic has separated health systems based on the impact of the pandemic on their staff, operations and finances. While many health systems have struggled in these areas, some have truly succeeded. This means that stakeholders developing relationships with health systems to improve outcomes must do so through the use of their specific pharmaceutical […]
Promoting Treatment of the ‘Right’ Patient
Every treatment has a patient population that truly benefits from the intervention. This population starts with those targeted in the pivotal trials but typically grows from there based on real-world evidence (RWE) and prescriber experiences. At the other end of the spectrum from patients who benefit are those who have dissatisfying outcomes from the same […]
BLOG: Moving to More Comprehensive HEOR Data
Health economics and outcomes research (HEOR) by definition is a discipline that is used to complement traditional clinical development information (i.e., efficacy, safety, quality) to guide patient access decision-makers to specific drugs and services. The foundation of HEOR is typically set by the finances that managed care payers are responsible for. This limits assessment to financial […]
BLOG: Targeting the ‘Right’ Patient — How Pharmaceutical Companies Can Help Physicians Connect Patients to the Right Treatments
Not every drug is right for every patient, but for some — or the “right” patient — treatment can provide significant clinical and financial benefits. For new therapies, identification of the right patient can be a challenging journey. This journey is best started by first targeting the most appropriate patients while additional evidence is developed […]
BLOG: Medication Adherence Opportunities and Challenges
“Drugs don’t work in patients who don’t take them.” − Former U.S. Surgeon General C. Everett Coop While it seems obvious, the amount of attention given to adherence is extremely low, especially in comparison to the high costs associated with non-adherence. A recent review published in the Annals of Internal Medicine estimated that a lack of adherence causes nearly 125,000 […]
BLOG: ‘Bundling’ Payments to Assure Appropriate Rx Use
In Medicare’s drive to improve outcomes of the fee-for-service (FFS) payment model, this model is being replaced with value-based care. The delivery of value-based care is not supported by FFS payments, which incentivize the volume of services delivered. Rather, value-based care is more aligned with a bundled payment model in which providers are directly held […]
BLOG: Pharmaceutical Value-based Contracts: Adherence and Supportive Contracts
While there is a great deal of talk regarding value-based contracts in the life sciences industry, there are few successful examples. The difficulties in structuring these contracts begin with identification of outcomes that are directly and primarily related to a specific treatment. In addition, these outcomes need to be readily and easily available to track. […]
BLOG: Medical vs. Pharmacy Benefit: A Look at UM Differences
Medicare medical and pharmacy benefits are very different in their utilization management (UM). As such, it is valuable to know the distinctions between benefits, as strategies differ depending on which ones apply. The most significant differentiator is the fact that utilization is typically greater under the medical benefit, as Medicare does not do any prior […]
BLOG: Gaining Coverage for Emerging Medical Technologies
The line between medical and personal care is everchanging. In all areas of our lives there is coverage through medical benefits, but the exact line between this and one’s personal responsibilities is not always as clear, and it is evolving. Whether it be transportation, housing or food, medical coverage is provided. Although not always considered, […]
Navigating Payer Formularies and Meeting Payer Needs — and Why It Matters
In a market where all healthcare stakeholders expect more from manufacturers, payers are no exception. As payers work to support patients and meet their own industry needs, manufacturers need to understand payer processes to improve patient treatment access. To start, payers have lists of covered drug products called “formularies.” These lists are organized by products […]
Pharmaceutical Opportunities and Challenges Facing Long-Term Care Facilities
Skilled nursing facilities (SNF) and long-term care (LTC) facilities have been a major source for news stories throughout the COVID-19 pandemic due to the devastation brought to patient populations. Now, pharmaceutical manufacturers have an opportunity to support these facilities and patients that companies may not have considered before. As an LTC facility owner/operator, medical director […]
BLOG: The ABCDs of Medicare Drug Coverage
The Medicare benefit is divided into four parts, each providing a unique drug benefit. Together, the four parts provide medication coverage – from oral medications taken at home to IV treatments given in a physician’s office to all medication provided during a hospital stay. Of course, many coverage details are in a constant state of […]
BLOG: Not So Rare… The True Impact of Rare Diseases
Rare disease treatments seem to be everywhere today. This is true despite the fact that to be considered a rare disease, fewer than 200,000 patients are affected — and for ultra-rare, fewer than 7,000 patients are affected. This definition was created by Congress in the Orphan Drug Act of 1983. Rare diseases became known as orphan diseases because drug companies were not interested in adopting them to develop treatments. The Orphan Drug Act created financial incentives to […]
BLOG: Population Health Leadership
“Population health” is the result of pushing health systems to be clinically and financially responsible for their communities. This is a significant shift from simply being focused on the volume of services delivered within the hospital. The focus on population health represents a movement for pharma from the past (targeting physicians due to their control of prescriptions) to managed care organizations during the heydays of HMOs to our current […]
BLOG: “Payvider” Growth Continues — But Not From the Payers
“Payviders” is the term used to describe the coming together of both payers and providers. In the past several years this has been driven primarily by provider consolidation. As these providers have grown into large, sophisticated groups or wind up under health systems, they seek out risk — serving the role of the payer as well — through becoming a payvider. But those same factors that have pushed providers to take […]
Under the Biden Team & Beyond COVID … What Lies Ahead for Healthcare
While the obvious healthcare focus for the new Biden/Harris Administration will be on controlling the COVID-19 pandemic, it’s a critical time to assess what lies beyond COVID for their attention. To gain a sense of what’s to come — like assessing the future season for your favorite sports team — one starts with who makes […]
Approaching Clinical Pathway Development as an Art
Much like any artform, creating a clinical pathway requires forethought, innovative design and strategic execution in the hands of the physician — except in the art of healthcare, the most important critic is the patient. While physicians try to perfect the art of patient care, the market realities of sky-rocketing costs and fewer resources influence […]
Impact of COVID-19 on the Quadruple Aim
COVID-19 has transformed the practices of healthcare professionals as well as the patient journey, leaving lasting impacts on the Quadruple Aim — cost, patient experience, population health and healthcare provider (HCP)/staff support. As independent, private medical groups have seen a 60% decrease in patient volume through the COVID-19 outbreak, physicians are moving their practices to […]
Population Health Partnerships To Advance Value-Based Care
The business model for health care in the United States is evolving from a volume-driven model to a consumer-centric, value-driven model. As such, there are new competencies required of hospitals and health systems to effectively manage a population’s health across the continuum of care. Many hospitals and health systems will need to partner with other […]
CMS Proposed Medicaid Rule: Best Price Impacts of Value-Based Purchasing, Co-Pay Assistance Programs, and More
On June 17, 2020, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule outlining nine specific changes to Medicaid regulations. Five of these directly affect manufacturers through changes in administration of the Medicaid Drug Rebate Program (MDRP): Value-based Purchasing Arrangements Line Extensions Patient Assistance Programs MDRP Definition Clarifications Authorized Generics Download EVERSANA’s […]
Where Health Systems are in the Shift to Value: Four Categories
One could make the argument that there are four situational categories under which all health systems now fall on the journey toward more value-based care and away from the fee-for-service model. Assisting health systems in successfully transitioning to value-based care and delivering improved clinical and financial outcomes for their patient populations depends on very different […]
How COVID-19 will Change the Patient Journey, Reimbursement, and Care Delivery
Value-based care has led to much change in healthcare over the years, and COVID-19 is pushing change faster and even further. These changes forced by COVID-19 will have long-term effects on every aspect of care delivery; current healthcare tools and programs such as clinical pathways need to adjust to these changes to continue being helpful. […]
Oncolytic Biosimilars: An Opportunity to Reduce Oncology Treatment Costs
Inclusion of oncology biosimilars in clinical pathways is one approach to reducing costs in this therapeutic area without compromising outcomes for cancer patients. There are currently eight Food and Drug Administration (FDA)-approved oncolytic biosimilars in the US market. Patients, providers, payers, policymakers, and manufacturers are all stakeholders that will be affected by these new biosimilars—and […]
Proactive Steps to Ensure Appropriate Utilization of the First Disease-Modifying Therapy for Alzheimer Disease
Widespread hope exists that aducanumab will soon gain Food and Drug Administration approval as the first disease-modifying therapy for patients with mild cognitive impairment associated with Alzheimer disease (AD), which could significantly impact the management of AD. If approved, challenges need to be addressed to properly identify patients who will benefit from treatment and ensure […]
Clinical Pathways and Policy to Guard Against Misaligned Incentives
The application of clinical pathways and their enforcement through quality metric benchmark setting and appropriate use criteria is needed to guard against perverse financial incentives that encourage overutilization and underutilization. Moving forward, the more diligent payers and integrated delivery networks can be in evaluating and incorporating utilization criteria when establishing clinical pathways, the better off […]
Oncology Treatment Access in 2020 and Beyond
2020 promises to be eye-opening as the coming election will surely provide clarity to the path that we will be taking for oncology treatment access. From international reference pricing, acceleration of biosimilars and generics, and allowance of reimportation – pressure continues to mount to reduce pharmaceutical prices, especially those used to treat cancer. Much of […]
Alexa, Can You Transform Healthcare?
“Alexa…,” “Hey Siri…,” “OK Google…,” “Hey Cortana…,” and “Hi Bixby….” These are the now-familiar “wake words” that we use to interact with our digital assistants and an ever-growing number of smart speakers. Chances are you have even interacted with one or more of these devices today. According to Allied Market Research, the smart speaker market is expected […]
Federal Enforcement of Clinical Pathways Resource Utilization Management
Providers order unnecessary tests for a variety of reasons: pressure from patients, fears of malpractice suit, not being knowledgeable about current “best” practices as well as for potential financial advantage for them or their health system. Clinical pathways built on solid clinical guidelines have the potential to lower costs through reduced resource utilization of potentially, […]
Ramifications of “Medicare for All” and Implications for Clinical Pathways
As the Medicare for All (M4A) debate continues into 2020, clinical pathway organizations, payers, health systems, providers, and patients will all play a role in shaping future policies around patient access and reimbursement. While it is certain that clinical pathways are shaping and will continue to shape health care regardless of system, what is far […]
Balancing Access
Value propositions need to justify product pricing by focusing on the burden of severe illnesses and how the products address unmet needs.
Could CMS Policies Impact Investments in CAR T-cell Therapies and Other Innovative Treatments?
Clinical pathways that include CAR T-cell therapy as an option must integrate appropriate guidance on its use and settings of care.
Pathways for Paying for Rare Disease Treatments
This article was written for the Journal of Clinical Pathways Determining how to pay for the treatment of uncommon yet serious diseases is an important consideration in terms of sustainability and patient access. Novel and expensive therapies will create financial pressure for payers’ drug budgets. Clinical pathways have demonstrated success at determining the “right treatment […]
CMO Perspective on World without Medicare Rebates
Written for Med Ad News Magazine by Dr. Richard Stefanacci For chief medical officers (MO) of health systems, a world without Medicare rebates complicates the selection of a preferred treatment while also opening opportunities for improved clinical and financial outcomes. This is the result of Medicare rebates being eliminated, potentially being replaced by patient assistance […]
How the Proposed Elimination of Medicare Rebates Would Impact Clinical Pathways
Government, Policy & Systems Changes Affecting Clinical Pathways This article is written by Dr. Richard Stefanacci, for Clinical Pathways Magazine. The Centers for Medicare & Medicaid Services (CMS) has published a range of new proposed and final rules regarding payment rates and policies affecting providers, payers, and patients. The Trump administration has also laid out […]