Impact of HEOR on Payer Decision Making

Published Online:June 23, 2014
There is increasing evidence that improving patient outcomes and cultivating value in the healthcare environment will require health economics and outcomes research (HEOR). Nicole Hengst, research director, Health Strategies Group, provided a unique perspective into some of the ways that payers can utilize HEOR to guide their decision-making practices.

Ms Hengst says her organization, Health Strategies Group, which provides market insight research to pharmaceutical and biotechnology professionals, conducted a survey of 71 payer executives from health plans, employers, and pharmacy benefit managers. It also included a more intense 30 minute interview process with 25 of those respondents. The survey probed into how these payers view HEOR studies, how they use HEOR studies to make access decisions in the top therapeutic categories,  and how their decision-making or patient engagement processes  are evolving due to the use of HEOR studies.

The Health Strategies Group found that payers perceive greater value in studies from particular HEOR sources. Academic or third party vendors were cited as “highly reliable.” They also found that payers utilize information from biopharmaceutical companies for contracting decisions. Payers rely on internal HEOR data to make decisions, including those for formulary decisions or treatment plans. The data was found to influence access restrictions and interventions.

“As we go from a fee-for-service to value-based [model], we put strain on our hospitals, health systems, and providers. So what are they looking to do? They need information, analytics, tools, data capture, [etc.] to make the right decisions and HEOR becomes that tool,” said Ms Hengst.

She suggested that the Montefiore Medical Center in Bronx, New York was just one health system that has successfully integrated HEOR into their strategic planning. Organizations like Montefiore can examine HEOR data and decide where to invest resources for treating conditions such as asthma, cancer, hepatitis, and HIV.

HEOR is only expected to increase in the next 2 to 5 years, said Ms Hengst. She explained it is due to:
  • A shift to value-based reimbursement from fee-for-service
  • The rise of population health management
  • The rise of consumer-driven healthcare
  • The growth of health information technology and analytic tools that allow systems to align across diverse platforms
  • Increasing use of specialty drugs and targeted therapies. Payers can also use HEOR to help tier their drugs.
HEOR provides stakeholders with a variety of other opportunities. Aside from making informed decisions about medical or pharmacy benefit design, it will allow payers to focus on a disease state. It will also help them to align with other stakeholders—including the “3-prong” payer, provider and patient arrangement—and to collaborate with others seeking to innovate.