As gene therapy and other one-time, high-priced treatments reach the market, the U.S. healthcare system will need to adapt to a new way of treating patients. MICHAEL SHERMAN, the chief medical officer of Harvard Pilgrim Health Care, has been a leader in trying to figure out how to do that, by experimenting with new payment models. Early this year, Harvard Pilgrim became the first insurance company to endorse an outcomes-based payment scheme for a gene therapy, Luxturna. The insurer is fronting the cost for Luxturna and is getting partial rebates or refunds from the manufacturer, Spark Therapeutics, if the treatment wears off.
Michael Sherman, Harvard Pilgrim Health Care • Photography by David Fox Photographer