As more of the healthcare industry moves to value-based contracts, it is imperative that managed care organizations can successfully measure outcomes.
As the healthcare industry moves toward innovative payment models based on value over volume, payers are struggling to keep up. Connor Willis, a researcher at the Pharmacotherapy Outcomes Research Center at the University of Utah, says that many payer organizations, even with value-based care staring them straight in the face, are unable to measure and monitor outcomes in real-time, putting them at a distinct disadvantage of successfully leveraging value-based contracts.
“A key issue for many managed care organizations is what kind of data they are capable of extracting in an efficient manner,” he says. “It’s very difficult for these organizations to get at because they simply aren’t set up to do so. The way things are coded and stored are such that it’s not easily extractable-it’s not meant to be. So, you have to find a way to get at that data you need and that’s often easier said than done.”
Willis joined colleagues and fellow panelists, which included Diana Brixner, RPh, PhD, FAMCP, executive director of Pharmacotherapy Outcomes Research Center at the University of Utah, and Kenneth Schaecher, MD, associate chief medical officer at the University of Utah Health Plans, to discuss the challenges of outcome measurement for managed care organizations-as well as some potential solutions for getting at value-based outcomes data-at the Academy of Managed Care Pharmacy (AMCP) Nexus event, to be held October 29-November 1, 2019, in National Harbor, Maryland, in the session, “Addressing the Challenges of Value-Based Outcomes Measurement.” The session was held on October 31, 2019, from 8:00 a.m. to 9:30 a.m.
Willis and colleagues discussed their own experience with how the Pharmacotherapy Outcomes Research Center helped the University of Utah Health Plan gain some of the data they needed for value-based outcomes planning. He said more and more groups are collecting this sort of data-and managed care organizations can benefit from working with them.
“There are a lot of academic outcomes research groups popping up all over the country,” Willis says. “Our own group has experience pulling the data and have a data infrastructure that’s already set up, with the expertise in pulling and analyzing outcomes data in an efficient manner. So, we’re trying to establish a relationship with the University of Utah Health Plan so that they can look at their data, pull it, and clean it up in a way that can easily be analyzed and used for value-based contracts.”
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Willis admits it is, no doubt, a challenging endeavor. But it is a necessary one. He said, slowly but surely, the healthcare industry understands that the current fee-for-service model is not working-and innovative value-based programs are necessary.
“Managed care plans are going to have to implement these kind of payment models if they are going to stay competitive with other health plans,” he explains. “Forming these contracts is kind of a symbiotic relationship. We’re at the stage where we’re assessing whether value-based contracting is the way we should go or if we should target more value-based insurance designs, like waiving co-pays for certain medications and certain types of patients. Pharmacy benefit managers are negotiating these contracts. And value-based contracting may be a future endeavor, but as the industry keeps evolving, we can’t know the way forward without that data.”
Willis added that managed care plans need to fine tune their data structure and platforms to make them more accessible-and outcomes research groups can help. But there are things that health plans can start doing now to better ready themselves for value-based contracting.
“Having people on staff to start doing some preliminary analyses to approach pharmaceutical companies with is really important,” he says. “A lot of issues with value-based contracting are due to poor value assessment studies going into negotiations. The payer, and, in many cases, the pharmaceutical company doesn’t know how valuable their product is. So, having some of these value assessments completed right then helps you better sure your contracts will be more effective.”
Kayt Sukel is a science and health writer based outside Houston.