Dr Lou Garrison on the Discussions Surrounding Outcomes-Based Arrangements

Although it may be costly to negotiate and implement risk-based arrangements, these agreements are a valuable tool for testing outcomes in the real world among complex patients, explained Lou Garrison, PhD, professor emeritus in the Department of Pharmacy, University of Washington.
Transcript (slightly modified)
As we move from fee-for-service to value-based models of care and payment, how are risk-based arrangements meeting the needs of the various stakeholders, including the patient?
At this stage, I wouldn’t say we’re meeting those needs. I would say that there’s tremendous interest around the US healthcare system with many manufacturers and payers looking to outcomes-based agreements. Most times, there’s a lot of discussion and it’s only rarely that something is implemented, and that’s because of things like negotiation issues, the costs of negotiation, the costs of setting up the data infrastructure, make it difficult to reach agreement and measure the things that you need to measure.
Now, obviously, in certain circumstances, it’s very difficult to measure long-term outcomes, for example. You have to do long, expensive trials or follow-up, so that makes it a challenge because the decision is often around launch and negotiating the price at launch. I think that’s making it difficult, but it’s clear there’s more interest, and as we improve our data systems, then hopefully we can measure those outcomes.
Again, I look at those agreements as the first step of measuring what happens in the real world, after that trial. We move from a situation where we may have a few hundred patients in a trial, versus up to 10,000 or 30,000 sometimes, but moving into tens of thousands of people in the real world. That’s what we want to see is how things are performing in the real world, in a more complicated mix of patients.
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