Panelists from Optum Life Sciences, OptumRx, and Takeda discussed the importance of collaboration in creating successful value-based agreements (VBAs) at Asembia 2023.
In the rapidly evolving landscape of health care, the concept of value-based care has gained significant momentum in recent years. This shift towards focusing on the value delivered by providers rather than just the volume of services rendered has led to the development of various value-based agreements.
At Asembia 2023, a panel led by Erin Hulbert, director of value-based contracting at Optum Life Sciences, discussed the importance of collaboration in creating successful value-based agreements (VBAs). Hulbert was joined by Mark Gimbert, vice president of specialty pharmacy and channel management at Takeda, and Alex Hindman, vice president of rebate strategy and account management at OptumRx.
Hulbert and Hindman started the conversation by explaining the partnership between Optum Life Sciences and OptumRx in creating successful VBAs. Serving as the point of contact for the pharmaceutical industry, OptumRx's industry relations team works to understand client pain points and identify VBA opportunities. They then collaborate with Optum Life Sciences' team to negotiate and develop these agreements, utilizing their data methodology and ability to compile data from both pharmacy and medical benefits to create a more comprehensive understanding of both the patient and client. Through this partnership, they have been able to create what they called “some of the best compliance VBAs” in the industry.
Gimbert went on to speak about Takeda's approach to VBAs. He stressed that Takeda is patient-focused and has a strong value system rooted in integrity, honesty, perseverance, and trust. To ensure their values are at the forefront of their decision-making, Takeda follows a governance model based on PTRB: patient, trust, reputation, and business.
“The order of that really matters, because we follow that order in a sequential manner from left to right,” Gimbert said.
Takeda also believes in simplifying the VBA process to make it more applicable to the real world. By focusing on meaningful clinical outcomes and designing with a purpose, they ensure they can start and finish the process while achieving the desired outcomes. Transparency is also a critical component of their VBA philosophy, and Takeda aims to share their modeling and predictions with partners to avoid any surprises.
“Our goal is we don't want to have known surprises throughout the process, and I think that ladders over to trust.” Gimbert said. “We look at value-based agreements as long-term commitments with each other, and they’re partnerships, they're not just transactions.”
By approaching VBAs with their core values and governance model in mind, Takeda has found success in making these agreements mutually beneficial for all parties involved.
Over at OptumRx, their goal is to align these agreements with expected or actual outcomes, and maintain sustainability while helping members and clients afford their medications. To achieve this goal, OptumRx formed a team that focuses on everything outside of traditional agreement method.
“In the spirit of keeping the definition simple, our approach has been that each one of these agreements are often very highly unique,” Hindman said. “You can’t come up with one deeper definition.”
When thinking about VBA criteria, OptumRx considers their clients' pain points, including high cost or ultra-high cost drugs, ensuring that clients pay a reasonable amount for the product when it works, and receive a discount when it doesn't work. They also consider new products that come to market relative to what would have been the gold standard at the time, and they address gaps in products with highly variable dosing to create predictability for their clients.
So how do organizations align these philosophies when partnering with other organizations? For Takeda, they do this by focusing on the main goal of patient centricity, considering what each organization can expect from each other, and aiming to find alignment around their values.
In addition to values, practicality is also essential in creating successful VBAs. Gimbert explained that part of their approach is focused on data, making sure to ask questions about whether the data is available and if they have the collective ability and resources to tap into it. In cases where they don't have the necessary resources, partnerships can leverage the expertise of other teams. By aligning their values and focusing on practicality, organizations like Takeda and their partners can identify problems early in the process and find solutions quicker, leading to increased opportunities for successful VBAs. Ultimately, this approach helps them to better serve patients and achieve their goals in providing affordable and accessible medications.
As an example, Gimbert and Hindman used hemophilia as an important disease that can be better served by VBAs.
Hemophilia A can lead to a range of complications, which can be more or less severe depending on the patient. One of the most common issues is breakthrough bleeds, which can occur up to 4 times a year on average. However, for more severe cases, the frequency can be 3 to 4 times greater.
Focusing on this, Takeda and OptumRx partnered to create a VBA focused on the clinical costs associated with the drug and hospitalization costs for patients who need to undergo treatment for breakthrough bleeds. Gimbert said this partnership allowed them to gain greater insight into OptumRx’s hemophilia A patient population and demonstrate the value that their own products bring.
The example illustrates how VBAs can benefit both patients and providers by focusing on outcomes that matter most to patients, and by aligning the goals of all stakeholders involved. By combining the perspectives and expertise of Takeda and Optum, the partnership was able to develop a practical solution that improved patient outcomes and reduced costs.
Hindman also highlighted that OptumRx’s clients have members with hemophilia within their plan sponsors, and that many of them are interested in understanding the relationship between hemophilia, medical costs, and treatment. Specifically, the focus of the partnership with Takeda is on the unexpected or unexplained bleeding events that occur despite being on appropriate hemophilia treatment, leading to increased medical costs and spending.
These unexpected bleeding events result in lost value for the client or member, prompting the need to generate meaningful information and data to understand the space better and put members and clients in a better position. This is why the team honed in on this basis to first understand the relationship, generate valuable data, and then develop a VBA that addresses the issue.
Now, when a member experiences a bleeding event despite receiving appropriate treatment, OptumRx has partnered with Takeda to exchange value for clients, allowing them to better manage the costs associated with these unexpected events. The development of VBAs for hemophilia has the potential to improve the lives of those affected by this rare genetic condition and reduce the financial burden on both patients and health care systems.