Dr Jane Barlow on Innovations, Limitations Within Alternative Payment Models

At the end of the day, the focus should be on improving the efficiency of our healthcare system and bringing cost-effective care to patients, said Jane Barlow, MD, MPH, MBA, EVP and Chief Clinical Officer for Real Endpoints.

Do you have a particular financing mechanism that you think has the most chance of being successful?
No, I don’t think there’s any one that’s going to emerge as the winner. I personally, because I'm a clinician, like the focus on outcomes and particularly meaningful outcomes that are improvements of health, or at least maintaining health and not having a deterioration. But I think there’s going to be a lot of different dependencies based on the payer, the different drug attributes, and other factors that may make one model work in one situation or another model work in another situation. At the end of the day, they really all should be focused on improving the efficiency of our healthcare system and bringing the best care to patients that they can at the lowest cost, but MEWS [modified early warning score] gives a lot of different ways you could get there.

Therapies are not the only area where alternative payment models are needed: what is happening in the diagnostic and genetic testing space?
There’s some interesting work that’s been going on in diagnostics. One example of a value-based deal in that area is one that occurred between Harvard Pilgrim and Illumina to offer trisomy testing, so noninvasive pregnancy testing for women under age 35 of average risk. They did a risk-based deal and showed that they had more anti-PTEN testing done, but they reduced invasive testing and they reduced overall testing. So, I think it’s better care for women and a better use of our resources in the healthcare system.

What are some limitations to alternative payment models that still need to be hammered out?
One of the biggest disconnects is the measures that we use for clinical trials, and approval of drugs may be very different than what’s practically attainable through claims data or even testing that a physician would do in their office and be able to report back. So, I think earlier on in the clinical trials, we really need to be thinking about how to bridge some of those outcome metrics to metrics that are attainable in the real world so that you can have a firm basis on which to do an outcomes-based agreement.
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