The eighth annual value-based care report shows that value-based care agreements have helped Humana members spend 245,000 fewer days in hospital than those whose doctors are not in a value-based care agreement The report explains how VBC providers connected patients to home care services, increased their use of telemedicine and addressed food security needs to continue to provide quality during the pandemic. to ensure a high quality supply. As a result, 86% of Humana MA members saw their primary care doctors based on value at least once in 2020, compared to 78% in non-value-based patients. Note: An important difference between BPAs and other types of agreements is that BPAs contain agreed performance and/or maintenance measures that meet the needs of users associated with the funding. The others do not. Scrutiny of high drug prices is unlikely to dissipate anytime soon, as highlighted in the Trump administration`s Master Plan2 and other bureaucratic initiatives. It is up to the pharmaceutical industry to take control by exploring other market solutions, such as value-based agreements that allow patients to access medicines without crippling them financially. Value-based agreements are still in their infancy and are likely to have even more difficulties in growth. The collaborative efforts around these agreements are nevertheless promising and demonstrate the willingness of health sector stakeholders to pursue innovative approaches to value-based agreements. The next wave of value-based agreements will expand access to new therapies, support the path from volume to value, and serve as a catalyst for healthcare contracting. HealthVerity enables manufacturers and payers to achieve these results by capturing and monitoring results in real time in a private, collaborative environment. From our perspective and experience, value-based agreements are part of a solution that allows for greater flexibility for payers and biopharmaceutical companies working together to support the transition to a value-based healthcare system.
Innovative value-based agreements should be designed to be based on how a drug, such as one of our diabetes drugs, behaves in a real world compared to a clinical trial. The result of reducing the risk of cardiovascular death does not always resonate with payers, which is why measuring the total cost of care savings relative to the previous standard of care was the basis of the value-based contract offering. Healthcare organizations continue to implement value-based agreements and contracts to pay providers and pharmaceutical companies based on the quality of care for the patient, not the amount of care to be provided or prescribed. The report, which consists of data collected in 2020 that describes the challenges providers and patients have faced during the COVID-19 pandemic, reflects the findings and experiences of 2.65 million Humana Medicare Advantage members seeking care at 67,800 primary care physicians under value-based agreements. “As a leading provider of innovative value-based agreements, AstraZeneca recognizes the need to move towards a greater focus on value and shared responsibility for patient outcomes. We have entered into value-based agreements in our therapeutic areas and are proud to support Symbicort`s science in this agreement with Highmark,” said Rick R. Suarez, Vice President, Market Access, AstraZeneca US. “Our goal is to provide patients with affordable access to AstraZeneca`s medicines, and this agreement fulfills our shared commitment to achieving better patient outcomes.” While much of the support for value-based contracts involves the concept of risk sharing between the manufacturer and the payer, the burden of this risk initially rests with health insurance. Before the payer sees the results of the predefined measurable outcome, they are responsible for covering the high costs of prescribed advanced therapies.
Depending on the clinical outcome, this could mean covering a few dozen prescriptions over months or even years. Defining these measures and reaching an agreement is a complex obstacle for stakeholders. Value-based contracts can offer pharmaceutical manufacturers the opportunity to improve patient access to innovative medicines and meet general sales expectations, but they come with unique challenges.11 Operationally, it can be difficult to determine appropriate outcome measures and define value over a specific evaluation point and time period. Other complications include procurement, management and costs of data collection. In addition, payers are concerned about the duration of the agreement, as it may be affected by the longevity of the plan beneficiary and the lack of portability of the terms.8 “Value-based providers had invested in the right infrastructure before COVID-19, making them more flexible and better able to use the technology, bring more care at home and be more responsive to the emerging needs of their patients and communities. ” said William Shrank, MD, MPHS, Chief Medical Officer of Humana…