Dr Somali Burgess on the Role of Patient-Reported Outcomes in Managed Care Pharmacy

The United States may not be ready for patient-reported outcomes (PROs) to be the sole decision maker in the contracting process yet, but the trend is toward PROs being included more and more in value-based processes, explained Somali Burgess, PhD, senior director, Xcenda.

How has the role of patient-reported outcomes in managed care pharmacy changed over recent years?
I am aware that there’s ongoing discussion around the importance of using patient-reported outcomes, or PROs, or PRO measures, and you’ll see it sometimes referred to as PROMs in value-based payment models as they relate to healthcare delivery, healthcare models, treatment patterns, treatment guidelines. But, I have to say that I haven’t seen as much discussion as it relates to drug pricing and contracting yet. And I think that there are still challenges that payers are facing to get us to that point of recognizing the importance of patient-reported outcomes measures, how they fit into the model, how they fit into the contracting process.

Overall, there’s also a lack, I feel, of consensus among drug manufacturers to realize how to use them but also to determine which validated measures should be used. So, as long as there’s a lack of consensus, it’s difficult to come to that standardized or that decision on which to use and how to use. While you can definitely use PRO measures to demonstrate efficacy, as part of a value-based model or the contracting process, there are challenges around collecting that data because there isn’t agreement on which ones to use. The perspective of the patient and the clinician has to be taken into consideration, and then to have a standardized method of data collection.

So, we may not be ready for patient-reported outcome measures to be sole decision-making points yet, but they are definitely being included, and I feel the trend is towards including PRO measures more and more in that value-based process.
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