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A leading pharmaceutical company is partnering with payers to help lower COPD complications.
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, affecting up to 24 million adults. The lung disease cost the healthcare system $32.1 billion in 2010 and is estimated to increase to $49 billion by 2020, according to the Centers for Disease Control and Prevention (CDC). COPD complications also contribute to 16.4 million lost work days, and $36 billion in lost productivity.
Boehringer Ingelheim Pharmaceuticals, Inc., one of the leading pharmaceutical companies that focuses on respiratory diseases, saw those staggering statistics as an opportunity to bring its expertise to a market that needed assistance with lowering COPD complications.
“With the market changes we are all facing, we as a pharmaceutical company wanted to be a more meaningful player in the industry. We wanted to change how we develop our products, and we realized the best way to figure that out is to talk to the people who are actually providing care,” says Ruchin Kansal, executive director and head of Business Innovation at Boehringer Ingelheim. A five-year partnership that initially focuses on COPD between Boehringer Ingelheim and Sutter Health, a California-based nonprofit health system that serves more than 3 million patients, aims to understand COPD patients’ behavior using mobile and digital technology paired with data analytics. The collaboration comes right on time: The state of California is estimated to spend $2.8 billion in COPD medical costs by 2020, according to the CDC.
“From that perspective, this collaboration is an opportunity for us to build off the experiences of providers, and the challenges they face,” Kansal says. “Sutter Health is unique in the fact that they have actually invested internally in research with an objective of finding efficiencies. Our collaboration will get deeper into care delivery and how it is provided.”
The goals of the partnership are to:
The companies will be using clinical data to get a better understanding of patient behavior in hopes of making COPD more manageable, Kansal says.
“We will be focusing more on electronic health records data. The value in that will be focused on why patients behave the way they behave. We can become really proactive about managing a disease, and begin to build cost predictions,” Kansal says.
Boehringer Ingelheim has been collaborating with payers to decrease healthcare cost for the past few years. In 2014, Boehringer Ingelheim, WellPoint and HealthCore collaborated on a multi-year project to create evidence-based guidelines for non-valvular atrial fibrillation. In 2013, the company partnered with Humana to improve outcomes and decrease healthcare costs for patients with COPD, cardiovascular disease, and other chronic diseases.
Collaborative models have become more commonplace between healthcare entities that previously never communicated. Historically, fee-for-service models and a lack of technology made it harder for payers and providers to establish trust and receive equal benefit from partnerships.
Payers reported that building trust, aligning incentives and calibrating goals with providers would improve patient outcomes and position organizations for success, in a 2013 survey of more than 300 healthcare executives conducted by Quintiles, a biopharmaceutical development company. More than 70% of respondents agreed that sharing data and information across stakeholder groups is instrumental to the success of an interoperable healthcare system. Despite these perspectives, only half of payers and providers said they were willing to be transparent.
“We are really starting to investigate how we can provide good quality care at a reasonable cost,” says Kansal, adding that all health systems need to start thinking about how care is provided throughout a patient’s experience. “To be able to do that I think the healthcare industry has to move away from the way we operated in the past-in silos. Whether it’s a payer, provider or a pharmaceutical company, the end goal is to provide the best patient care possible. If we can come together we can think about the real challenges and how we can solve them together.”
As the Affordable Care Act (ACA) demands price transparency and better data collection and analytics, collaborations between payers and providers have become one of the most effective ways to better understand and report information on patients, according to an April 2015 report on payer analytics post-ACA published by IDC Health Insights.
“While today’s payer analytics applications provide a comprehensive set of executive-level and individual line-of-business reporting capabilities, there is room for future improvement in terms of the potential for better big data management and the integration of clinical, financial, wearable, remote, and other important sources of healthcare data,” says Deanne Primozic Kasim, research director, Payer Health IT Strategies at IDC Health Insights. The report finds that the Centers for Medicare and Medicaid Services’ value-based and pay for performance programs incentivize collaborative business models in the healthcare industry.
Kansal adds that regulations and policies can sometimes limit collaborations, but there is still room for innovation between healthcare systems. He adds that Boehringer Ingelheim continues to consider partners who have the same goals and are willing to put up equal resources in order to obtain meaningful outcomes.
“In my mind there is only one issue and that is centered around the patient and how he is behaving today. Patients are taking on more financial burden, and are looking at healthcare services like they do retail services. Technology is making it easier for payers and providers to communicate for the sake of the patient,” Kansal says.
Donna Marbury is a writer in Columbus, Ohio.