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Value-Based Partnerships: Engaging in Value-Driven Innovative Collaborations

Value-Based Partnerships: Engaging in Value-Driven Innovative Collaborations

New Trends in Innovative Collaborations with Manufacturers

In the United States, annual per capita spending on healthcare reached $10,348 in 2016, with a projected growth rate of 5.5% per year for 2017 through 2026.1,2 In an effort to slow this rate of growth, the healthcare industry is engaging in multiple tactics, including greater use of value-based care models where outcomes are assessed by multiple factors including cost of treatment, clinical outcomes, and patient experience. The shift toward a value-based care environment is creating an opportunity for healthcare organizations and other stakeholders to engage in value-driven innovative collaborations that can help improve the way treatments are identified and care is delivered.3

In the biopharma industry, as the dialogue shifts away from pricing and toward the mutual goals of value-based care and population health, value-based partnerships (VBPs) between manufacturers and both payer and provider organizations are emerging. These partnerships allow partners to co-develop programs, solutions, and initiatives in a collaborative manner for the benefit of patients and the healthcare system and to further scientific knowledge in a therapeutic area.

In recent years, there have been several innovative value-based collaborations between manufacturers and healthcare organizations. These collaborations are innovative in that they examine complex, longitudinal, population health–relevant outcomes in hard-to-manage chronic conditions. Examples of recent VBPs include:
  • A 2013 partnership between Humana and Lilly used claims data to examine how drug interventions affect outcomes, adherence, and total costs. The partners have since signed additional agreements to run diverse studies of other chronic diseases.4
  • Also in 2013, Merck entered into an agreement with Heritage Provider Network, Inc (HPN), a southern California-based managed care organization that participates in the Pioneer Model accountable care organizations, to identify novel solutions in diabetes and heart disease that focus on development of processes and services that enhance outcomes independent of the pharmaceutical company’s products.5
  • In 2016, Merck announced 2 agreements with Aetna, with the aim to address gaps in the coordination of care and to support the achievement of health targets for patients with type 2 diabetes and/or hypertension.6
The wide range of potential benefits of collaborating include improvement of population health outcomes and reduction in potential “waste” to the healthcare system. Additional potential benefits in new collaborative partnerships include3:
  • Identification of new methods and measures for better economic value and efficiency
  • Design of models for assessing appropriate patient populations
  • Creation of opportunities to potentially increase value by promoting health-seeking behaviors
  • Testing of clinical diagnostic, screening, and therapeutic interventions through a value-guided approach
Amgen, headquartered in Thousand Oaks, California, has been one of the more forward-looking biopharma companies in developing VBPs with payers, providers, and other healthcare organizations, committing to the capability at the C-suite level and across multiple functions within the company. By engaging in value-based programs with entities across the healthcare system, including integrated delivery networks, health systems, payers, pharmacy benefit managers, health technology companies, and others, Amgen hopes to develop mutually beneficial opportunities to reduce costs, improve care, and enhance patient experiences. This reflects the company’s belief that managing disease through innovative medicine is key to containing healthcare costs and improving population health.

Defining Value-Based Partnerships

Amgen has engaged in VBPs with several organizations in the healthcare community, with the goal of developing scientific innovations, information, data, and insights that will better inform and potentially improve both the clinical outcomes and experiences of patients. Amgen defines a VBP as:
Two or more organizations sharing a mutually beneficial endeavor to deliver the highest value to the healthcare system and society by focusing on improving patient outcomes* in the context of system and societal total costs.
*Includes patients’ clinical outcomes, experiences, and satisfaction.
  • In Amgen’s view, the goals of projects executed through partnerships are to increase the quality of outcomes and/or decrease healthcare spend. The types of projects undertaken in a VBP vary, but may include:
  • Disease management
  • Patient/caregiver engagement initiatives
  • Digital solutions
  • Resource /data sharing
  • Data integration
  • Predictive modeling
Amgen envisions partnerships formed with not only payers and healthcare providers, but also with patient associations, technology companies, and research institutions. Each partnership has its own objectives and value drivers, and success is dependent on the VBP creating a mutually beneficial situation and tangible benefit for all engaged partners. Amgen views these partnerships as an essential first step toward establishing future long-term relationships in which additional value models may be explored.

To illustrate the potential of VBPs in action, case studies are presented through interviews with healthcare leaders whose organizations are engaged with Amgen in these efforts, as well as an interview with Amgen’s vice president of Global Value Based Partnerships. The interviews focus on their experiences in creating and managing a VBP, including their rationale for participation, areas of focus, and expected benefits, as well as organizational challenges and solutions.
Case Studies
Editors from the American Journal of Managed Care sat down with Todd C. Lord, PharmD, vice president, business development, Magellan Method, a division of Magellan Rx Management, Andrew L. Masica, MD, MSCI, chief clinical effectiveness Officer, Baylor Scott & White Health (BSWH), and Peter Juhn, MD, Vice President, Global Value Based Partnerships, Amgen to learn about the experiences these organizations have had in creating VBPs.

Magellan Method is a division of Magellan Rx Management, the pharmacy benefit management (PBM) division of Magellan Health, Inc. Magellan Method specializes in solving complex healthcare challenges through industry-leading managed care insights, customized clinical interventions, and real-world analytics, including both medical and pharmacy data.

As the largest not-for-profit​ health care system in Texas and one of the largest in the United States, BSWH was born from the 2013 merger of the Baylor Health Care System and Scott & White Healthcare. Today, Baylor Scott & White includes 48 hospitals; more than 1000 patient care sites; more than 9700 active physicians; over 47,000 employees; and the Scott &​ White Health Plan.

Founded in 1980, Amgen, Inc. is one of the world’s leading biotechnology companies, committed to unlocking the potential of biology for patients suffering from serious illness by discovering, developing, manufacturing, and delivering innovative human therapeutics. Amgen has a presence in approximately 100 countries and regions worldwide, focusing on 6 therapeutic areas: cardiovascular disease, oncology, bone health, neuroscience, nephrology, and inflammation.

Case Study on Value-based Partnerships between Amgen and members of the healthcare community: An Expert Perspective from Peter Juhn, MD

AJMC®: Why did Amgen develop a VBP model?

Juhn: Amgen created the VBP team and built this model because we recognize that to solve the biggest challenges in healthcare, we need to move beyond the purely transactional model of interacting with our customers/vendors and develop a more cooperative, collaborative approach to problem solving. Creating a partnership with experts from multiple areas in the healthcare environment means that each party brings to the relationship something unique. Also, by working together we can ensure the outcomes go beyond satisfying each party’s narrow self-interest.

AJMC®: What value does Amgen obtain from participating in VBPs?

Juhn: By working closely with our partners, Amgen gets a valuable “seat at the table” to work directly in true collaboration with key members of the healthcare community to address the big challenges facing healthcare worldwide—more effective therapeutics, more affordable care delivery, and the opportunity to help improve healthcare outcomes—clinical, economic and humanistic. We get a chance to work closely with experts from across the industry, and we’re able to act on learnings from the collaboration and improve upon our core mission of putting patients first.

AJMC®: Amgen has a highly defined process for VBPs, including necessary components for every partnership. What was the impetus behind the highly defined process for collaborating?

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