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

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

Lord: From the Magellan perspective, there are a few objectives for this collaboration. First, to provide a real-world example of the outcomes that can be generated from an innovative payer/pharma collaboration, to engage in more partnership opportunities in the future and ultimately find new ways of providing value to our clients. Second, to determine if a high-touch program can improve health outcomes in patients with osteoporosis, which would allow Magellan and Amgen to use these insights to co-develop a program that can be offered to other payers. Finally, we would like to be an innovator in the realm of VBPs through improved relationships with manufacturers like Amgen.

AJMC®: How will outcomes be measured?

Lord: Outcomes will be measured based on a comprehensive analysis of medical and pharmacy administrative claims data. There are several metrics that will be analyzed, including:
  • Number of patients and physicians engaged
  • Number of engagements per patient and physician
  • Qualitative patient engagement assessment
  • Number and percentage of DXA scans completed at 6 months and 1 year post fracture
  • Number and percentage of patients initiating appropriate pharmacologic osteoporosis therapy at 6 months and 1 year post fracture
  • Patient medication adherence
  • Changes in overall healthcare utilization [costs] pre- and post intervention
  • Although not a direct goal of the program, we’ll also be assessing the impact that this program has on osteoporosis-related quality metrics.
AJMC®: Besides benefits to your organization, what benefits to the patient population are expected through these partnerships and how will these patient benefits be measured?

Lord: Our hope is that the results and insights from this program will help inform and improve postfracture care with the number one objective to reduce subsequent fractures. This will be measured by the percent of patients receiving follow-up bone density scans and/or osteoporosis pharmacologic therapy within 6 months of having a fracture and by using administrative claims data to assess overall healthcare utilization.

AJMC®: Do Amgen and your organization have a communication plan currently in place to share new solutions or results arising from the partnership and to share program successes?

Lord: Not specifically, but we have agreed that we will work together to disseminate the information. This will be the responsibility of the JSC to determine the most appropriate avenue for results communication. Ideally, we’d like to publish the program results in a peer-reviewed journal, present the outcomes at industry conferences, and disseminate through other appropriate channels. On the Magellan side, we may potentially develop continuing medical education programs for our providers. In addition, both parties may have other mechanisms to share information with relevant stakeholders, including customers, to highlight the information, processes, and outcomes generated from a new approach to managing osteoporosis patients following a fracture.

AJMC®: Would you recommend this model or offer any advice for other organizations interested in this type of value-based collaborative partnership with a biotechnology company?

Lord: This is certainly a substantial time and resource commitment. Unfortunately, many healthcare stakeholders, including health plans, are strapped for both clinical and analytic resources and need a trusted third party to be able to carry the resource burden of implementing a partnership like this. This provides us with a unique opportunity to explore every possible avenue to provide information and insights to healthcare stakeholders. The healthcare environment is drastically changing, but what isn’t changing is the need to drive improved health outcomes as a strategy to reduce overall cost of care. If these partnerships can demonstrate a meaningful impact on quality of care or cost avoidance, then all healthcare stakeholders may begin to view partnerships with pharmaceutical manufacturers in a new light.

Case Study on Value-based Partnerships with Amgen and Baylor Scott & White: An Expert Perspective from Andrew L. Masica, MD, MSCI

AJMC®: What led you to explore a collaborative VBP with Amgen? What were your organization’s reasons for entering in a partnership like this with a biotechnology manufacturer?

Masica: For us, it’s about being cognizant of healthcare delivery in a market that is moving toward a value-based model where you’re increasingly being paid on quality and outcome measures rather than volume. In the context of that evolution, the relationship of industry and pharma has historically been transactional with integrated delivery organizations. To really be successful in the value-based marketplace, it must be more of a collaborative and mutually beneficial partnership. Both entities have a mutual interest in the patients served by the delivery organization. That’s where you want to leverage the partnership approach as opposed to a transactional model. VBPs also fit our broader organizational transformation and preparations to operate as a care delivery and wellness maintenance system of the future.

AJMC®: What was your internal process like for entering a formal partnership with Amgen?

Masica: Initial discussions focused on therapeutic areas of interest at BSWH and Amgen. Once we identified common priorities for both parties, it allowed us to explore the partnership further.

Each partner brings something different to the table, in terms of innovation and transforming care. Industry has the technology, business model, and resources to help develop new therapies. Delivery organizations can and should be directly involved in evidence generation and development of approaches for better care, but also represent the settings in which new therapies can be evaluated and applied.

Once there was a recognition of a potential shared benefit derived from a VBP, we had to look at specific questions. Did we have the right environment such that it would make sense to put this partnership in place? Were the therapeutic areas identified as a priority for our patient population as well as for our organization? Did the collective group have the right subject matter expertise? Could outcomes from the partnership address an area of need for us? As an example, one of the things we’re always trying to do as a delivery organization is to learn better ways to activate and engage patients. That was also a common interest for Amgen. Based on that convergence, patient engagement has been a central theme of the partnership to date.

AJMC®: When Amgen approached you, what was the process for making a partnership happen? Did it have to go up the ladder? Did others in your organization need selling or education around the details of a VBP?

Masica: “Value-based model” is a description commonly used when discussing healthcare transformation, but in the delivery organization-pharma relationship space, how that model operates day to day is still very much a work-in-progress. The first phase of partnership development entailed introductory conversations about whether we had mutual areas of interest. That was followed by additional due diligence surrounding what a specific project would actually look like. Who would be involved? How would resources be allocated? What were the legal and compliance components to consider?

Once we agreed on the program foundations, discussions became very granular in terms of logistics-contracting, deliverables, legal review, timelines, etc. The other fundamental question was, is this program research or is it more of an operational project? In our case, we felt this fell squarely into the operational, nonresearch space. After those structural pieces were in place, the emphasis shifted to pulling together a project work team and then executing.

AJMC®: Okay, can you tell us a little bit about what your project team looked like, and what type of individual roles are involved?

Masica: After making the determination that this was an operational project, we brought in other people from the organization involved with innovation and care transformation efforts. These included subject matter experts in primary care, care coordination, and patient education, as well as a data analyst and a project manager. That’s the core team on the BSWH side. This group interacts with other individuals across the organization on an as-needed basis in terms of reaching out to specific practice sites or obtaining perspectives from additional BSWH stakeholders. The BSWH core team works closely with a matching group on the Amgen side. My own connection to the project is a hybrid role, linking healthcare delivery science and operational improvement efforts.

AJMC®: Can you describe specifically some of the projects that the organization and Amgen will undertake together?

Masica: The collaborative work to date falls into several categories. First, we used data collected from normal BSWH care operations to characterize our population in terms of demographics, anti-hyperlipidemic use, and current LDL status. This real-world evidence informed our collaboration, with the end goal of designing a project to improve our understanding of potential care management options.

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