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

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

The other component surrounds patient engagement. To better understand that aspect of lipid management—for example, what factors are most important to patients as far as lipid medication adherence?—we conducted a series of patient interviews. Insights from this phase of our partnership could be used to co-develop disease education resources, patient engagement resources, or other patient-focused content. The final formats of what we will do with that content are still to be determined.

AJMC®: How will your organization and Amgen jointly make decisions as these projects unfold? If there are shifts or things that need to be addressed, is there a steering committee? What’s your communication structure like with Amgen for this program?

Masica: We do have a program steering committee, and we work directly with 2 project leads at Amgen in that capacity. BSWH members include myself, a vice president in the BSWH Value-Based Healthcare Institute—our quality improvement consulting resource that works with external entities—and our system director of patient learning. The steering committee generally meets monthly.

AJMC®: What are the organizational goals and benefits that you’re expecting from this program?

Masica: From the real-world evidence standpoint, with the array of new drug therapies coming onto the market, we are very interested in looking at net population benefits and total costs of care associated with those therapies, particularly when applied to environments similar to BSWH. I think there is a real opportunity for organizations to use their own data and work with industry partners to help answer those types of questions.

The other area of interest is generating actionable data or new approaches for the health coaches and clinical care managers throughout our accountable care organization, as well as our outpatient practice networks. We really didn’t have anything specifically developed for patient engagement and activation in the lipid management space. We felt there were some opportunities to improve care delivery and any learnings or tools that we could develop for that condition would be of mutual benefit for the patients served by BSWH as well as our providers.

I think that also highlights the difference between VBPs that emphasize shared knowledge generation versus value-based contracting. Historically, value-based contracting has often been a transactional arrangement driven by volume, where organizations purchase a certain amount of the drug and in return receive favorable pricing. That’s not what we’re setting up with Amgen. The partnership at this stage is really about laying some of the groundwork and conducting pilots to understand what the next generation of value-based agreements— for example, purchasing contracts with shared risk—and innovative care models to better serve patients might look like.

AJMC®: So your work with Amgen on this project does not have to do with a contract that may affect pricing for drug acquisition?

Masica: Correct. This partnership is not connected to any purchasing agreements. Again, at this stage, I view the partnership very much as a discovery and learning lab, generating pragmatic resources to help move the needle on clinical outcomes and providing insights.

AJMC®: Would you suggest this model or offer any other advice for other types of organizations interested in this type of collaborative partnership?

Masica: There is general acknowledgment that the market is going to evolve from fee-for-service to a predominantly value-based model. The timing and the specific mechanisms for how that’s going to happen are much less clear. There’s not really a standard organizational blueprint for how to make such a transition easily or quickly. That gap creates a situation where a joint learning partnership can provide a tremendous amount of value to the healthcare system. You can use the partnership as a rapid-cycle innovation environment to test new ideas, and it may lead you to some insights, information, or products that support better patient care or could improve healthcare outcomes overall that might not have been pursued otherwise. These types of partnerships can accelerate the discovery phase and move the healthcare system toward those value-based care approaches faster.

AJMC®: What does value mean to BSWH?

Masica: On a high level, BSWH’s conception of value, like that of many organizations, is the relationship of quality versus cost of services provided, as well as access to those services. Within that framework of value, and specifically in the pharmacotherapy space, I think the concept of tailoring care and matching the right patient with the right treatment becomes very important. For example, is there a patient who might benefit from being on a specific medication therapy that’s not receiving it? This would be an underuse problem. Conversely, is a patient taking a medication which is unlikely to help their condition or has risks that outweigh potential benefits? This would be an overuse problem. Likewise, does a patient have access to their prescribed medication and are they taking it appropriately? Each of these scenarios impacts the relative value of pharmacotherapy.

Other aspects of value relate to the things we do that benefit our patients’ experience and the efficiency of care delivery. Frequently, there is still significant equipoise in the value equation with novel therapies. For example, what’s the downstream impact of higher spending for a new drug on clinical and cost and outcomes, both to the patient and to the delivery organization? From a total cost-of-care perspective, it may be very reasonable to spend more on the front end of a longitudinal care episode, if, at a population level, it yields net tangible benefits. As mentioned previously, this type of analysis done at the local level represents a potent type of real-world evidence. 

Lastly, value can depend on the perspective of who is doing the assessment. On the patient side, value could be a lower out-of-pocket cost for a therapy or a clinical outcome that improves quality of life or an ability to work. For a delivery organization or a payer, value may lie in determining initial cost of the therapy versus the total cost of care and the impact on the broader covered population. Everyone uses the term “value,” but it is often helpful to view the question through the lens of “value to whom?”

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5. Bhandari A, Chatterjee A, Holoubek S, Powers B, Gluck J, Jain SH. A novel pharmaceutical-ACO collaboration: the Merck/Heritage Provider Network open innovation challenge. Am J Manag Care. 2014;20(10 Spec No):E4.
6. Lee J. Merck and Aetna pair population health with risk-sharing in two deals. Med Mark Media website. Published January 29, 2017. Accessed May 29, 2018.
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