Chester "Bernie" Good, MD, MPH, senior medical director of the Center for Value Based Pharmacy Initiatives at UPMC Health Plan, talks about the evolution of value-based contracts.
More industry partners are getting comfortable with doing value-baseed contracts, said Chester "Bernie" Good, MD, MPH, senior medical director of the Center for Value Based Pharmacy Initiatives at UPMC Health Plan during the Academy of Managed Care Pharmacy Nexus 2022 fall meeting.
How have value-based contracts evolved, and how do you see them evolving going forward?
A few years ago, value-based contracts were somewhat of a novelty, not many people had done them. I think what has evolved is that a lot of people, a lot of industry partners have gotten very comfortable with doing these contracts. So that's, I think, one of the biggest things that I've seen, is that there's a lot more comfort and everyone seems to be doing them. I think, also, there's been some evolution in looking at some of the newer innovative therapies. I think there's a lot of interest in gene therapy, so there's been a lot of movement in that area. That's an area that still needs to evolve.
Are there any payment models in development for curative care?
We have not done any innovative payment models yet for some of the gene therapies that are very expensive; we simply just have paid for them. But these have been relatively rare diseases, so we don't have many patients that are getting those gene or cell therapies. I think what will push us to looking at innovative payment models will be when some of the disease states such as treatment for hemophilia, where we have a lot of potential patients that might be candidates, and I think that will force us into looking at different payment arrangements. I think there are a lot of challenges, and I don't know where we're going to end up with these. There's a lot of concern about portability, so if you give someone a gene therapy that hopefully cures their disease, and they aren't in your system very long, how is that payment spread over other payers, if that's possible? Some of the payment models that are out there try to address that by doing it with an annuity or payment over time.
How do these contracts consider patients who face barriers in accessing gene therapies?
So, you're getting at social determinants of health. That goes beyond gene therapies, but any innovative therapies. What can we do to make sure that there is equal access to patients? It's a tough nut to crack. Hopefully, if someone is in your insured population, you as an insurer are doing what you can to make sure that these innovative therapies are available to those patients who would most benefit regardless of what their station in life is. It's something that we've been looking at: How do you identify those patients who really should be given access to these therapies, but for whatever reason are not? But it's a challenge.