You down with VBP? (Yeah you know me.)

It's been nearly 20 years since policymakers had the seemingly smart idea of paying for value in health care, but it's less clear than ever what value-based payment means, and whatever it is, it hasn't lived up to the hype, my colleague John Wilkerson writes.

The idea behind value-based payment, also known as value-based care, seems simple enough. Public and private health insurers and others in the system should encourage care that focuses on performance and the patient experience. If you keep people healthy, fewer will end up in hospitals, where care is the most expensive.

But talk to enough experts in the field, and poof, the concept turns into a puff of smoke. John dives into what is clear — and what simply isn't, still.

in the weeds

Is pot research going to get any easier?

The Biden administration's announcement this month that it will downgrade marijuana from the most restrictive class of drugs would seem to open up new avenues for researchers who have long been stymied by the federal government's decades-old declaration that the drug is just as dangerous as heroin and LSD.

It could mean more labs get easier and quicker access to cannabis, which is already available in some legal form in 41 states. It could also mean that more researchers grow the plant in the potent forms already on the market. But researchers who spoke with STAT said there are myriad unanswered questions about what happens next. Any change is better than the status quo, they argued.

Nick Florko and I walk through four major questions about where rescheduling leaves researchers and what they want to know about cannabis' medical use.

2025 watch

The GOP's perilous tax credit problem

From my co-author Rachel Cohrs Zhang: 2025 is going to be a tax battle in Congress, and positioning is already kicking off. WIth the Trump tax cuts and Affordable Care Act premium subsidies expiring, it's all going to be a major topic of conversation.

The American Rescue Plan's premium tax credits have Democratic policy written all over them. They were passed by a trifecta Democratic government without a single Republican vote, and bolster the Affordable Care Act, which the GOP hasn't historically been too fond of.

So it's no surprise the GOP think tank crowd isn't a fan of the subsidies. Former Trump White House advisers Theo Merkel and Brian Blase came out this week with a treatise on health care and tax policy that suggests, among other proposals, that the GOP should let the subsidies expire.

However, some of the states that benefit most from the subsidies are dominated by Republicans. Projections by the Urban Institute of how many people could lose marketplace coverage if the subsidies expire show the three states that would be most impacted are Florida, Texas, and Georgia.

clinical trials

Even NIH-funded clinical trials often aren't diverse enough

Clinical trials that the National Institutes of Health funds often enroll fewer Black patients and other underrepresented racial groups than they plan to, according to a study of 30 NIH-funded trials sampled by the HHS Office of Inspector General.

The OIG findings are in line with other studies from outside the government, according to William Fitzsimmons, a founder of the CARER Group, which is pushing to improve trial diversity. However, those studies looked at clinical trials funded by drug and medical device companies.

"One would assume that the academic NIH studies may perform better on diversity, but that doesn't appear to be the case," Fitzsimmons said.

FDA policy

FDA overwhelmingly urged to ban electric shock devices

With a deadline for public comment this week, the FDA received hundreds of responses to its proposal to bar the use of electric stimulation devices on people with behavioral issues. Many called the proposed ban an "overdue" move on a "horrific" practice and pointed to one place in particular — Judge Rotenberg Educational Center in Massachusetts — that still using the devices.

Electric shock had just a handful of supporters among nearly 800 comments. One was Ilana Slaff-Galatan, a doctor and president of the Rotenberg Center's parents' association. Slaff-Galatan argued that other treatments — such as pharmaceuticals — aren't as effective. But the vast majority of behavioral experts disagree.

Because JRC is the only behavioral treatment center in the country still believed to be using this method, a Massachusetts lawmaker brought it up in an FDA budget hearing last month. "I do know that the Geneva Convention regards these devices as torture. But I also have a group of families in my district who… have children and loved ones who are undergoing these treatments, and they claim that those treatments help," Rep. Stephen Lynch (D-Mass.) told FDA Commissioner Robert Califf before urging him to meet with the families. Califf encouraged families to submit comments to the docket.

For more on the long history of the electric shock debate and where it goes from here, keep an eye on my colleague Timmy Broderick's byline or reach out to them.

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What we're reading

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