14th Annual Maui Dermatology Meeting: The future of dermatology or its demise

Abstract

On January 29, 2018, on behalf of the Women’s Dermatologic Society, Dr. Lenore Kakita, Past President; Dr. Mary Maloney, Current President; and Dr. Julia Baltz, Resident Representative were asked to facilitate a discussion at the 14th Annual Maui Dermatology Meeting entitled “The future of dermatology or its demise.” The panel included Dr. Barbara Gilchrest of Harvard Medical School; Dr. James Leyden of the University of Pennsylvania; Victor Bulto, Vice President of Novartis Immunology and Dermatology; and Robert Bitterman, Sr. CEO of Cutanea Life Sciences. What ensued was a lively discussion on technology in dermatology, patient access to a growing arsenal of medications, and the resultant rise in health care costs. Dr. Maloney started the evening by inviting panelists to give their opinion on patients’ increased access to their health care records. Mr. Bulto of Novartis was quick to point out that there is at times a discordant balance of power between the various stakeholders of health including the patient, provider, and payer but that ultimately increasing patient engagement leads to better patient outcomes. Similarly, Drs. Gilchrest and Baltz agreed that increased patient engagement is inevitable and it behooves providers to educate their patients on the ways that they can use technology to effect positive change on both the microlevel of individual patient care and macrolevel in developing systems-based models that integrate technology. When discussing electronic medical records, the panelists readily admitted their frustration with a disruption in meaningful patient-provider interactions and the immense amount of after-hours work that falls on the physician. Despite these frustrations, the panelists agreed that in time electronic medical records could provide useful information for medical innovation through the collection of big data. Similarly, the group felt that teledermatology and increased access to diagnostic technology are additional high-impact inevitabilities in our specialty. Drs. Leyden, Gilchrest, and Maloney cited increasing evidence on the ways in which technology can improve access to care and diagnostic accuracy. Specialty pharmacies and the high cost of biologic medications were topics of particular interest and concern to panelists and audience members alike. Mr. Bitterman provided an excellent overview of the reasons that a pharmaceutical company may choose to contract with specialty pharmacies preferentially over chain drugstores. Notably, specialty pharmacies allow for agreed-upon pricing of medications and thus standardizing the reimbursement to the company and the amount paid by a patient. In contrast, chain drug stores have a greater ability to substitute the prescribed drug with a generic or therapeutic equivalent to maximize profitability. Pharmacy Benefit Managers (PBM) are instrumental in setting the formulary for various health care plans. PBMs are incentivized to put more expensive medications on formulary because this leads to higher percentage-based rebates from drug manufactures to PBMs. The panel concluded on the need for better transparency at every level of the drug delivery system. In answer to the closing question on medication pricing, Mr. Bulto and Mr. Bitterman elucidated to the group the ways in which drug prices are decided. The multifactorial metrics of drug pricing include societal value of a drug, geographic variations on the cost of living and access, and the investment of research and development in the setting of an increasingly saturated market. The panel discussion was led by Drs. Kakita, Maloney, and Baltz and allowed for a spirited debate between clinical and research physicians and our partners in the pharmaceutical industry. It is safe to say that a greater level of understanding was reached on both sides with regard to the intricacies of providing care in a rapidly changing medical landscape and the evening radiated a spirit of optimism for the future of dermatology. Photo Captions Top: Thank you to our panel participants and facilitators (left to right), Victor Bulto; Dr. James Leyden; Dr. Julia Baltz; Dr. Barbara Gilchrest; Dr. Lenore Kakita; Dr. Mary Maloney; Robert Bitterman, Sr.; and George Martin, MD for a lively discussion on technology in dermatology, patient access to a growing arsenal of medications, and the resultant rise in health care costs in a discussion entitled “The future of dermatology or its demise.” Bottom left: The panelists discuss patients’ increased access to their health care records, specialty pharmacies, the high cost of biologic medications, and medication pricing. Bottom right: The audience was very engaged in the discussion and left with a greater level of understanding of the intricacies of providing care in a rapidly changing medical landscape. The evening radiated a spirit of optimism for the future of dermatology. Unlabelled Image