Patti’s People, from The Evidence Base

In this ‘Patti’s People’ episode, Patti Peeples of the The Peeples Collaborative speaks with Michael Drummond, Professor Emeritus and former Director, Centre for Health Economics, University of York, where they discuss topics including the evolving role of health economists in policy, the ongoing debate about “Value” in healthcare, and budget constraints and opportunity cost in health systems.Questions:00:00: Introduction01:23: Health economists now sit closer to power than ever. Is their role still primarily to inform policy, or has the field crossed into shaping it – and where should that line be drawn?03:46: How can economists best help policymakers understand alternative options and opportunity costs without drifting into advocacy?06:19: Have we reached a genuine stand-off in the healthcare value debate, or have underlying philosophical differences simply become impossible to smooth over?15:58: Why do health systems and even health economists struggle to confront the reality of scarcity, and what real-world examples illustrate this? 21:22: Is HEOR being asked to stretch beyond its traditional focus on efficiency and equity into broader industrial strategy, and are we equipped to do that well? Michael DrummondProfessor Emeritus and former Director, Centre for Health Economics, University of YorkMichael Drummond is Professor Emeritus and former Director of the Centre for Health Economics at the University of York in the UK. His main field of interest is in the methodology and practise of economic evaluation in health care. He is the author of two major textbooks and more than 750 scientific papers. He has advised several governments on the assessment of health technologies and acted as a consultant to many life sciences companies. In October 2010 he was made a member of the National Academy of Medicine in the USA. He served for 14 years as Co-Editor-in-Chief of Value in Health and was made Editor Emeritus in May 2024.

In this ‘Patti’s People’ episode, Patti Peeples of the The Peeples Collaborative speaks with Ramiro Gilardino, Healthcare Executive specializing in Global Access & Health Policy.Questions:00:00: Introduction01:16: What’s changing in pricing reform, and why is this moment important?03:11: How do MFN and reference pricing work, and how do they differ in purpose and impact?06:18: Why are these tools so appealing to policymakers?07:00: MFN pricing is often framed as a fairness issue. From an access and economics perspective, where does that argument fall short? 09:35: One concern is that MFN doesn’t just affect the US, it reshapes global pricing behavior. What ripple effects do you see internationally? 12:40: External reference pricing has been around for decades. Why does it feel more consequential, and more dangerous, now than it did 10 or 15 years ago?15:18: People still talk about ‘Europe’ as if it’s one access environment. Why is that framing fundamentally flawed?18:30: From your experience in consulting and industry, what does true organizational readiness for European access actually look like? 21:01: How early is ‘early enough’ when it comes to European access planning, and what needs to be decided before Phase III?22:58: With more coordination across Europe, there was hope for simplification. Are we actually seeing simplification, or just a new layer of complexity?25:39: As a CrossFit coach, you use “explain, demonstrate, practice, correct.” How does that approach apply to communicating value in access today?27:15: What does it take to tell an access story that resonates with payers, policymakers, and patients beyond the science and policy? 28:38: Rapid Fire Questions Ramiro GilardinoHealthcare Executive specializing in Global Access & Health PolicyRamiro Gilardino, MD, MSc, is a health policy and innovation specialist with a background spanning global institutions and the private sector. He brings over a decade of experience in HTA, market access policy, and evidence strategy. Ramiro has led and contributed to international collaborations focused on aligning HTA methodologies, advancing affordability frameworks, and enabling lifecycle approaches to decision-making. He currently serves on the Board of Directors at ISPOR, where he champions stakeholder engagement, equity, and policy reform to enhance patient access and making healthcare accessible and affordable.

In this Patti’s People episode, Patti Peeples of the The Peeples Collaborative speaks with Paul Scuffham, Founder, Centre for Applied Health Economics.Questions:00:00: Introduction01:24: What do you see as the real purpose of health economics today?05:17: Australia’s National Health and Medical Research Strategy is being revisited for the first time in a decade. What is the significance of reassessing R&D spending now, and how could it reshape priorities across hospitals, universities, and health-service research?09:06: Australia’s PBAC is known globally for rigor and transparency. What does PBAC consistently get right – and where could it improve?12:48: It can take nearly three years from FDA approval to PBAC listing. Where could the system meaningfully shorten that pathway without weakening the evidence? 19:41: More than 300 oncology drugs were approved globally in five years, yet few reached Australia. Are sponsors more deterred by pricing expectations or by process complexity? 22:48: What does smart, ethical engagement between academia and industry look like in 2025?25:16: Many universities push for impact yet primarily reward publications. How can institutions better recognize and value policy-relevant or commercial translation work?29:37: ISPOR’s 2030 Vision calls for bridging evidence and equitable access. What is the single biggest shift needed to achieve that? 32:21: Amid geopolitical and economic pressures, how do you see global pricing and value frameworks evolving – and what might this mean for patient access?34:01: Healthcare spending is outpacing GDP worldwide. Is sustainability fundamentally an economic problem or a political one?36:30: If Australia could share HTA workload with one other agency, who would it be, and why?37:52: You’ve mentored a generation of health economists. What advice would you give your younger self, or emerging economists hoping to influence policy today?40:56: Rapid Fire Questions Paul ScuffhamFounder, Centre for Applied Health EconomicsChair of Health Economics, School of Medicine & Dentistry, Griffith UniversityProfessor Scuffham’s research is focused on identifying the value for money of healthcare interventions, elicitation of preferences from patients and the public, and methods of priority setting. He applies his research interests across the breadth of cardiac conditions, genomics, digital health, vaccines and more. At Griffith University, Queensland Australia, he founded the Centre for Applied Health Economics and was Director of the former Menzies Health Institute Queensland, a large research institute with 13 centers and over 500 staff. In his professional society, he was the inaugural President of the Australian Chapter of ISPOR, and past Chair of the Asia Consortium. He was awarded ISPOR’s Marilyn Dix-Smith Leadership Award in 2025. He is a Fellow, Board member, and Chair of the Policy Advisory Committee of the Australian Academy of Health & Medical Sciences. He is a member of the Research Committee of the National Health and Medical Research Committee and a member of the Public Health and Health Systems Committee of the Medical Research Future Fund & NHMRC.

Questions:01:08: How have your personal experiences shaped your understanding of evidence, access, and impact in health policy?03:24: What core principles have remained constant throughout your work across advocacy, government, and consulting in health policy?05:20: Can you share an example of a well-designed policy that failed at the implementation stage, and what you learned from it?06:26: What lessons from implementing the ACA have shaped your approach to structuring practical, workable health policy frameworks today?08:45: If you were designing a US HTA framework today, what would you build differently to make it work in practice?11:28: What are your reflections on ICER’s current assessment process, and how could it be improved to make its findings more useful and actionable across the healthcare system?14:25: Why does the US continue to struggle to fully integrate evidence generation into its pricing and access frameworks?16:35: If you could design an incentive structure to encourage pharmaceutical companies to share their data, what would it look like and how would you make it work in practice?20:03: What do you see as the most effective way to align FDA and CMS around patient-centered access?25:11: If you could design a structured communication process between CMS and industry, what would it look like?27:28: Can you share an example of how stakeholder feedback directly improved CMS implementation efforts?35:06: What emerging policy and regulatory trends will most influence pharma market access and RWE over the next decade, and which are still being underestimated?39:57: Amid rising costs and solvency challenges, what gives you confidence that the US can bend the healthcare cost curve without stifling innovation?Kristi MartinDirector, Camber CollectiveKristi Martin brings over 20 years of experience shaping health policy through practical, impactful solutions. Currently a Director at Camber Collective, she pairs analytic rigor with a human-centered approach to advance strategies that improve health and well-being. She guides mission-driven organizations through complex health policy landscapes through her own firm, Highway 136 Consulting, which was founded in 2020.Kristi’s career spans government, philanthropy, and consulting – always focused on making healthcare better and fairer. Most recently, she served as Chief of Staff for Medicare at the Centers for Medicare & Medicaid Services (CMS), where she led strategy and execution for major initiatives under the Inflation Reduction Act, including Medicare drug price negotiations.Previously, Kristi was Vice President for Health Care at Arnold Ventures, managing their portfolio to lower prescription drug costs. As Managing Director at Waxman Strategies, she provided strategic counsel to foundations and advocacy organizations on issues ranging from prescription drug pricing to women’s health. Earlier, she played a key role in implementing provisions of the Affordable Care Act, advising senior officials, and coordinating policy across federal agencies at the Department of Health and Human Services, CMS, and the Office of Personnel Management. Her federal service across these agencies as well as Government Accountability Office and National Institutes of Health gave her a strong foundation in policy development and implementation. Her roots in DC are in patient advocacy as she started her career with Easter Seals and the American Cancer Society.Known for turning bold ideas into action, Kristi has advised the White House, represented US interests internationally, and built consensus among diverse stakeholders. She holds a Master of Public Administration from George Washington University and earned both a master’s and bachelor’s degree from the University of Kentucky.

In this ‘Patti’s People’ episode, Patti Peeples of the The Peeples Collaborative speaks with Jason Shafrin, Senior Managing Director, Center for Health Economics and Policy, FTI Consulting.Questions:00:00: Introduction01:15: You’ve worked across government, pharma, consulting, NGOs, and academia. What ties it all together, and what are you trying to solve now?03:35: Was there a moment that drew you to health economics, or was it a gradual pull?05:47: You’ve written on value frameworks and outcomes for reimbursement. If you could redesign HTA from scratch, what would you toss and what would you keep?09:53: You’ve said incentives drive behavior, and competing incentives are a constant challenge. What’s the most misaligned incentive in healthcare today – and who does it hurt most?15:19: With growing scrutiny of RWE and digital health, is oversight enabling or stifling innovation?17:54: What’s one policy or regulation you believe is well-intentioned, but has led to poor health or economic outcomes?22:31: On July 31, President Trump asked 17 pharma companies to match US drug prices to other developed nations. As a health economist, do you think this will work?27:14: Rapid Fire Questions Jason ShafrinSenior Managing Director, Center for Health Economics and Policy, FTI ConsultingJason Shafrin, PhD, is a Senior Managing Director at FTI Consulting's Center for Healthcare Economics and Policy. Dr Shafrin has over 20 years of health economics research experience serving as trusted advisor and expert to a wide variety of healthcare and life sciences companies, governments and non-governmental organizations (NGOs). Dr Shafrin is an Adjunct Professor at the University of Southern California, the former Director of Research at the Innovation and Value Initiative and the Founder and Editor of the Healthcare Economist blog. Dr Shafrin is an expert in applied economics with a specialty in health economics research. Over his career, he has developed novel methodological approaches, advanced quantitative analyses and innovative modeling to address some of the most difficult health economics problems and provide evidence-based solutions for clients across the healthcare industry. His work has assisted clients in addressing policy changes, navigating regulatory processes, evaluating pricing, value and outcomes and supporting innovation and transformative change. Dr Shafrin’s extensive experience includes projects on value assessment, alternative payment model design, discrete choice experiment survey, real-world data analysis, and digital medicine.

In this ‘Patti’s People’ episode, Patti Peeples of the The Peeples Collaborative speaks with Kirsten Axelsen, Senior Policy Advisor, DLA Piper.Questions:00:00: Introduction01:02: You entered biopharma through econometrics and discrimination litigation – what connects that work to what you’re solving now?04:50: You built analytical tools to prioritize policy battles. What’s one battle you lost that still keeps you up at night?09:03: You’ve said predicting this administration’s moves is impossible. What tools help you turn that chaos into strategy?14:13: You’ve warned that China is overtaking US clinical development. How real is this shift, what’s driving it, and what are we still in denial about?18:39: You’ve advocated for more carrots than sticks in policy. What’s the most promising incentive we’re overlooking to drive real health outcomes?20:32: What, if anything, should health economists and outcomes researchers be saying about issues like biosimilars potentially disappearing and China’s rise?23:04: If rebates disappeared tomorrow, what reform would you pursue to make formularies more clinically honest and economically sustainable?25:48: You publish in both journals and op-eds—how do you balance academic neutrality with policy persuasion? 28:38: At recent ISPORs, there’s been debate that HEOR, RWE and market access departments struggle to clearly demonstrate their impact within pharma and policy. What’s your take?30:22: Can you share an example where health economics truly shaped a policy decision?32:12: Rapid Fire QuestionsKirsten AxelsenSenior Policy Advisor, DLA PiperKirsten works with leaders in life sciences to navigate policy, competition, reimbursement and public perception for successful product launch, growth and profitability. She has developed and executed strategies at all stages of the biopharmaceutical lifecycle in all major markets. Kirsten brings more than 25 years of experience working in life sciences. She is a biopharmaceutical consultant and an Aspen Institute Health Fellow.

In this ‘Patti’s People’ episode, Patti Peeples of the The Peeples Collaborative speaks with Eberechukwu Onukwugha, Professor and Executive Director of Pharmaceutical Research Computing, University of Maryland, Baltimore.Questions:00:00: Introduction01:26: What’s something outside your professional life that has shaped how you show up day to day?07:14: Can you share a time when data conflicted with lived experience and shifted your perspective or approach to research?11:06: Has a single patient story ever changed your perspective more than large datasets? How should research methods account for that?16:03: As ISPOR President, what conversations are we still not having loudly enough in HEOR or HTA circles?20:08: As AI scales, how can we ensure underrepresented regions aren’t left behind – and what’s your approach to bridging that gap?24:49: What can behavioral science teach us about improving health outcomes that traditional models miss?27:55: How should we address gaps in data that overlook patients’ economic realities, like out-of-pocket costs or caregiving burdens?30:56: How do we train the next generation of HEOR professionals not just to code, but to care? Where are we missing the mark?39:38: Rapid Fire QuestionsEberechukwu OnukwughaProfessor and Executive Director of Pharmaceutical Research Computing, University of Maryland, BaltimoreEberechukwu Onukwugha, PhD, is a Professor in the Department of Practice, Sciences, and Health Outcomes Research and is Executive Director of Pharmaceutical Research Computing at University of Maryland School of Pharmacy. She received a doctorate degree in economics from Virginia Tech and has 20 years of experience conducting health economics and outcomes research. She has authored 140 peer-reviewed articles. She is an editorial board member for PharmacoEconomics and an Associate Editor for Ethnicity & Disease.