Executive Chairman Update


Update to Members

July 2017

Max Hamburger, M.D.

Founder and Executive Chairman

It has been some time since you received an update from me, and for those of you notice these sorts of things, you might see a change in my title to Founder and Executive Chairman. Last fall, United Rheumatology began a search for a Chief Executive Officer, a natural next step given our growth in operations and scope. In March, our search process concluded with the selection of Jon Glaudemans, formerly of Manatt Health, as our new CEO. Previously, Jon had been working with me and the company in a consulting capacity, and many of you had the opportunity to hear Jon speak recently at either the Miami or Dallas meetings. Jon has over 35 years of health business and health policy experience, and as Founder and Executive Chairman, I look forward to working with Jon on behalf of each of you and the independent rheumatology community.
Below, I provide updates on many of the programs and services designed to help you treat your patients and maintain a viable independent community-based practice. If you have any questions or suggestions, please call me directly at 516-236-0915, or Jon at 202-803-1796. We welcome and value your engagement.
Group Purchasing Organization (GPO): United Rheumatology’s GPO (UR-GPO) offers our members highly-competitive prices and services for a wide range of drugs and supplies. I am proud to announce that UR’s GPO has been successful in working with a number of manufacturers, including UCB, Janssen, and, just concluded, BMS, to provide very competitive pricing for your drug purchases. In addition to our direct-to-manufacturer relationships, we continue to partner with CuraScript (CSD), the ExpressScripts (ESI) specialty pharmacy division, and Matrix, CSD’s GPO affiliate, to expand the offering of drugs with country-wide best pricing.  While there are several GPOs in the market, ours is the only one designed by and for the independent rheumatology practice.
One of the many benefits of membership is our ability to address any issues you might experience in the timely and efficient ordering and receipt of your drug and medical supplies. Please have your office contact Amanda Byrnes (Amanda@unitedrheumatology.org) for assistance. Amanda is our Senior Director for Operations, and can usually resolve any issues quickly. Even if you believe you can solve the problems without our intervention, if you give us a heads-up, we can raise these opportunities for improvement during regular business reviews with Matrix, ESI and CuraScript.
Daily Newsletter: In January, we launched our daily newsletter: United Rheumatology Today. UR Today provides up-to-the moment updates on policy and government affairs developments, clinical and basic science developments, and United Rheumatology activities. Many of you appear to be using this daily update, and we encourage all of the members to try a subscription. It arrives in your email inbox at about 6:00 am eastern time. If you have suggestions to improve the newsletter, please let us know.
Policy Engagement: United Rheumatology continues to advocate on behalf of high-value, patient-focused care through our engagement with The Institute for Clinical and Economic Review (ICER). As many of you know, ICER is one of the several organizations assessing the value and efficacy of drug therapies, and their findings have been used by payers and policymakers in making coverage, prior authorization, formulary tiering and step therapy decisions. ICER recently reviewed the clinical efficacy of various treatments for, respectively, rheumatoid arthritis (RA) and osteoporosis. In both reports, United Rheumatology played a significant advisory role in helping ICER staff and panels understand the real-world perspective of independent community-based rheumatologists. Specifically, we were the only physician organization asked to send a representative to the ICER-sponsored RA stakeholder meeting in Boston on March 24, and we engaged extensively on the importance of addressing the needs of patients at very-high-risk of fracture in ICER’s osteoporosis report. While ICER’s findings are their own, we are proud of our ability to reinforce the patient and community rheumatologists’ perspectives in their analyses.
Medical Policy Committee: As part of our commitment to deliver high-quality care to our patients, and to demonstrate the value of community-provided rheumatologic care, we created a Medical Policy Committee (MPC), and charged it with a very clear goal: to develop Care Pathways that reflect how we – the membership of UR – treat our patients, and to make these Care Pathways practical for the physician, and measurable to help us define our value to patients and payers. In their two-year existence, the MPC has developed a set of copyrighted United Rheumatology Care Pathways (UR-CPs) for the treatment of: rheumatoid arthritis; psoriatic arthritis; spondyloarthritis; osteoporosis; knee osteoarthritis; and gout. The MPC has also developed a UR-endorsed Position Statement on the use of biosimilars, as well as a related CME program. These Pathways and Statements are available for your review and use via the United Rheumatology website.
Let me provide a little context for our decision to create the MPC and to embark on the ambitious effort to define Care Pathways. In considering whether even to develop these Care Pathways, we were very sensitive to the concerns expressed by many about externally-imposed guidelines and pathways. In this regard, it is essential to understand that we currently are beset with Guidelines and Pathways that have not been drafted by practicing rheumatologists, but that often are developed by or on behalf of various stakeholders in the system with no or limited responsibility for patient care. There seems no realistic chance to practice in an environment without Pathways. Thus, to challenge others’ pathways as, alternately, wrong, too restrictive, or too vague as to be meaningless, we felt incumbent to develop our own Care Pathways. The development process of each of these UR Care Pathways was lengthy, often with day-long discussions among the members of the MPC, and each UR Care Pathway benefited from expert advice from colleagues such as such as Josef Smolen, Daniel Aletaha, Larry Edwards, and Joel Kremer. As a fellow community rheumatologist, I think the MPC took considerable care, and listened carefully, to develop Pathways that can and should serve as a guide to our decision-making as we treat our patients. Consistent with the pace of science and medicine, the MPC is a standing committee, and, among other duties, will update the UR Care Pathways as appropriate and from time to time. I know I speak for the Committee when I invite your feedback on the Care Pathways. In addition, if you are interested in serving on the MPC, please let me know; members serve for two years, and we welcome volunteers for positions as members’ terms come to a conclusion.
What will UR do with these Pathways? As described below, we are actively engaged in conversations with multiple payers in 5 geographic areas, and our Pathways are our expression of our expertise and solidarity. Our conversations with these payers are in their early stages, and among other goals, we are focused on seeking alternatives to the cumbersome third-party prior authorization, step edit, and formulary tiering requirements.
Initial Discussions with Key Payers and PBMs: Many of us have experienced restrictive formularies, onerous prior approval processes, and the vagaries of drug pricing and other policies imposed on our practices and often negatively impacting patients’ access to care.   We are pleased that ExpressScripts has demonstrated a tangible commitment to working directly with United Rheumatology to explore a partnership on ways to improve our ability to care for our patients.
In addition to some creative partnership ideas under active consideration, we also have a good working relationship with their senior leadership; we can help you and your practice resolve issues that may arise in your interactions with Express Scripts. Sometimes, for example, a very restrictive formulary has been developed for the benefit of a self-insured employer who uses ESI to manage their drug and medical benefits. While ESI will appear to be the source of the formulary policy, they are in fact acting in accordance with the contracted directives of a client. This is but one example of an instance where the media identify ESI as the “culprit” when in fact it is the self-insured employer who has chosen a highly restrictive formulary. If we are to address these matters, we need to know accurately who is responsible. With a single phone call, UR leadership can get to that information from the ESI CMO – another example of the value of the size and scope of our membership.
We expect to have much more to report on this at our annual meeting in Orlando this fall.
Some Internal Updates: We have moved into our new offices at 521 Route 111, Hauppauge, New York. The expansion into this space will accommodate our growing staff; among other positions, we are in the midst of adding a staffer fully dedicated to data and data analytics.
Expanding Focus on Data and Analytics: United is embarking on a collaborative relationship with Jeff Curtis MD, at UAB. Jeff is a prolific investigator, and has had a particular interest in data and data analytics. With this collaborative undertaking, UR gains access to a substantial team with a breadth of experience in the collection and analysis of chart data. Our estimation of the best opportunities to take advantage of the value of aggregated chart data – both for optimizing our practices and to support payer negotiations- has expanded substantially during 2017. We are exploring a variety of options with commercial entities., and with a cautious approach to timelines, we expect to have an update on the role of chart data to help sustain our independence at our fall membership meeting (details below). The data and analytics are critical to UR forming a Clinically Integrated Network, which will be foundational for our payer relationships and negotiations in the future.
Identifying Additional Service Offerings: UR has been evaluating the issue of in-office pharmacy/dispensing (IOP/D) opportunity for two years. There are challenges- in some states, a pharmacist must be on premises in a unique physical space. How manufacturers, payers, major specialty pharmacies, PBMs and distributors will respond to an IOP/D is not predictable. This is an area with some potential for financial risk, and where the PBMs in particular, but also drug manufacturers are under intense political scrutiny for pricing and the impact of rebates. UR expects to be able to designate one or two possible vendor partners that its members might utilize after we complete legal and regulatory and compliance review and due diligence. Many of you are aware of a few particular successes with rheumatology-owned IOPs. The pharmaceutical industry has been engaging in conversations with rheumatologists along with other subspecialties (particularly those where drug prices have been rapidly escalating as expensive new molecular entities enter the marketplace). While we are aware of the success stories, there are also failures which don’t receive the same attention. Before UR “officially” engages on this matter, we will make certain we understand the opportunities and risk to the best of our capacity and share that information with you.
Our Growing Footprint: We are pleased to announce that our membership now stands at 340 active members, and I am especially pleased that we are in a position to offer complimentary membership in United Rheumatology to 10 of our fellows. These bright and energetic fellows are our future. I have invited them to participate in all UR activities. We want to grow the number of fellows within the UR family, so please feel encouraged to introduce fellows to UR, and we will actively follow through on leads you provide.
We continue to recruit practicing community physicians. We will conduct a series of dinner meetings over the balance of 2017 across the country. We are most successful when we have a local champion helping us with recruitment. If you are interested in helping as a local champion, please contact Amanda Byrnes at the UR offices. (amanda@unitedrheumatology.org)
Our Upcoming Meetings: Continuing our tradition of convening members periodically to discuss issues and opportunities for the community rheumatologist, the Medical Policy Committee meets twice more this year — August 24-26, and November 30 – December 2. Our Eastern National Meeting is in Orlando October 20-21; we look forward to seeing you there. Please look for an invitation shortly.
Many of us will also be attending the ACR’s annual conference in San Diego. While not part of the official conference, United Rheumatology is hosting a dinner at Mr. A’s in San Diego on Monday, November 6. We will send invitations to you as appropriate for each of these in a timely way.
For next year, we will also soon publish the 2018 Meeting Schedule in the UR Today Newsletter. Our national programs will include CME programs on Clinical Pathways, Data Analytics, and other topics of interest – for example, sessions on novel therapeutics or diagnostics as they become available. In addition, we expect these meetings to include national and international clinical and policy thought leaders.
In closing, I want to thank each of you for the outpouring of love and support you showed me during the most difficult of days of my life, when my wife of 45 years passed away after a short and agonizing illness. She and I created United Rheumatology together, in support of our mutual commitment to establishing a mission-based organization to support independent community-based rheumatologists.
Your continued support as we continue the mission is deeply appreciated.
Max Hamburger, M.D.
Founder & Executive Chairman
United Rheumatology

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