Currently Viewing:
AMCP 2017
Analyzing the Near-Term Pipeline for Specialty Drugs
March 28, 2017
Dr Aimee Tharaldson Highlights Two Key Drugs for 2017
March 28, 2017
Effectively Moving Toward Value-Based Care
March 28, 2017
Susan A. Cantrell on the Evolution of Value Frameworks
March 28, 2017
Dr Liz Zhou Explains Basal Insulin Switching Study on Toujeo
March 28, 2017
Dr Richard Willke on Using Real-World Data to Inform Value-Based Contracts
March 29, 2017
The Unsustainably Big Business of Healthcare
March 29, 2017
Dr Matthew Pickering: How Quality Measures Are Created and Implemented
March 29, 2017
Addressing the Affordability Issue of Novel Treatments
March 29, 2017
Dr Clifford Goodman Outlines Takeaways From a Health Economic Case Study on Repatha
March 30, 2017
Dr Doug Hillblom on the State of e-Prescribing and Remaining Barriers
March 30, 2017
Cardiovascular Outcome Trials: How Misinterpretation of Statistics Can Affect Clinical Practice
March 30, 2017
Repatha Offers Additional LDL-C Reduction in a Convenient Dosage Form
March 30, 2017
ACA Repeal and Other Healthcare Issues on the Trump Administration's Agenda
April 03, 2017
Currently Reading
The Latest in the Move to Value-Based Reimbursement and Remaining Challenges
April 04, 2017
Dr Aimee Tharaldson Discusses 2 New Treatments for Tardive Dyskinesia
April 12, 2017
Dr Gail Bridges Explains the High Real-World Cure Rate for HCV
April 17, 2017
Dr Richard Willke Previews ISPOR 2017 in Boston
April 18, 2017
Dr Matthew Pickering Discusses Development, Implementation of Quality Measures
April 20, 2017
Dr Doug Hillblom Expects Evolution of e-Prescribing to Continue
April 22, 2017
Dr Aimee Tharaldson: We're Keeping an Eye on Future NASH Treatments
April 27, 2017
Susan A. Cantrell Outlines Concerns and Opportunities for Managed Care
May 01, 2017
The Importance of Ethical Committees in the Evolving Healthcare Environment
May 11, 2017
Dr Lou Garrison on the Discussions Surrounding Outcomes-Based Arrangements
May 17, 2017

The Latest in the Move to Value-Based Reimbursement and Remaining Challenges

Laura Joszt
Panelists, during a session on value and value-based reimbursement at the Academy of Managed Care Pharmacy Annual Meeting, held March 27-30 in Denver, Colorado, discussed the benefits and challenges of value-based contracting and the current and evolving use of value frameworks.
Although there has been an increased interest in value-based contracting, the most common type, pay-for-performance, has had mixed results to date, and many challenges remain.
 
Panelists, during a session on value and value-based reimbursement at the Academy of Managed Care Pharmacy Annual Meeting, held March 27-30 in Denver, Colorado, discussed the benefits and challenges of value-based contracting and the current and evolving use of value frameworks.
 
Tomas J. Philipson, PhD, Daniel Levin Professor of Public Policy Studies at the University of Chicago, started the session by outlining the 5 challenges that have faced value-based contracting so far:
  1. There is a need for stronger incentives. According to Philipson, efforts in this space have so far been small, with maybe 1% to 2% of payments being on quality and the rest still on volume.
  2. Value needs to be measured appropriately. Pay-for-performance has focused on processes because measuring outcomes is more difficult. In order to have more of an impact, there needs to be an understanding of what measures are valuable to patients.
  3. Patient preferences need to be accommodated.
  4. Don’t get too complex. These contracts should start simple and not get too complex too quickly.
  5. Innovation should be rewarded.
 
Peter Neumann, ScD, director of Center for the Evaluation of Value and Risk in Health Tufts Medical Center, said all the efforts to measure value has created an “interesting period of value frameworks.”
 
He finds it important that the value frameworks out there, such as the National Comprehensive Cancer Networks’ Evidence Blocks, the Institute for Clinical and Economic Review (ICER)’s Value Assessment Framework, and Memorial Sloan Kettering Cancer Center (MSK)’s DrugAbacus, are all coming from the private sector.
 
“You may not like them, but you can’t blame the government for doing this to you,” he said.
 
In other countries, the value frameworks are a government function, and the fact that they are coming from the private sector is not only uniquely American, but means that they are here to stay, Neumann said.
 
That these frameworks all have different approaches does make it difficult to compare them. They all measure clinical benefit in some way, but only MSK considers novelty of treatment and the rarity and burden of the disease, and only ICER takes into account budget impact.
 


 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up