This year’s J.P. Morgan Healthcare Conference will address some of the biggest managed care trends, including next-gen at-risk contracts and access to therapy as cancer trends towards a chronic condition.
O'ConnorEvery year, the business of healthcare gathers en masse at the annual J.P. Morgan Healthcare Conference. This year’s conference will be held January 9 to January 12 in San Francisco. What will we learn? What will we hear? What will be missing?
Because of the nature of the forum, companies are a bit light in presenting substance when it comes to patient care. This conference is about the healthcare business, not necessarily the patient care business. The conference is an opportunity to highlight value to the entire continuum by putting the focus on the patient from which positive outcomes in personal health, population health and economic health emanate.
1. At-risk contracts 2.0: Will real value make an appearance?
Every year we hear about new therapies that have completed phase three trials and are about to be commercially launched, along with the manufacturers speaking to their drugs’ pricing. The CEOs of pharma manufacturers will, of course, be messaging directly to analysts.
From the payers and PBMs, we will hear pushback on the cost of specialty medications and that manufacturers may be cut out of payers’ formularies if pricing, value and efficacy are not proven for new specialty therapies.
The movement toward value-based pharma arrived in late 2015 with Amgen’s pay for performance agreement with Harvard Pilgrim for the PCSK9 inhibitor Repatha. Yet the first generation of at-risk contracts between manufacturers and payers appeared to be little more than value-based window dressing.
From an article I wrote earlier this year in Managed Healthcare Executive, “As the only drug on formulary within these agreements, manufacturers are still banking on a simple volumetric percentage of efficacy to meet payment and profit goals. Real improvements in outcomes and value-based contracts require more lifestyle factor measurement and corresponding agreement on their evaluation.”
Curant Health President and CEO, Patrick Dunham, along with Javier Mendez, VP Pharmacy Operations for Virginia Premier Health Plan, discussed four key components for successful outcomes-based contracts at the Asembia 2016 conference. They include engagement of pharmacy partners with medication management protocols shown to improve adherence and outcomes, agreed upon up-front data sharing and outcomes measurement, and neutral arbiters of that data in order to achieve their value-based potential.
What can we learn about the latest at-risk contracts between manufacturers and payers at J.P. Morgan 2017? Is either party improving value, where value is defined as outcomes divided by cost? We are eager to find out.
2. Cancer’s trend to a chronic condition
Increasing survival rates among cancer patients are a leading indication that the future of cancer treatment may start to mirror the treatment of chronic conditions. Such a shift will have massive effects on payers and will accelerate difficult conversations and decisions about the value of extending life. Oncology patients on new immunotherapies are demonstrating three to five-year survival rates and 30% remissions.
There exists a massive difference for the continuum between paying $120,000 or more for one year of therapy with six- to 12-month survival rates for cancer patients compared with the same $120,000 per year for an indefinite number of years as treatment efficacy grows.
What’s needed to prepare for cancer’s trend to a chronic condition? Managed care executives would be wise to start with development of a chronic care management team (inclusive of clinical pharmacists) responsible for providing patient support and assistance, patient education and counseling and improved sharing of information to improve adherence to medication protocols.
Who will have access to which therapies and who is going to pay for it? We will be listening closely for any insights payers share on the topic.
3. National healthcare policy
What the future holds for the Affordable Care Act is anyone’s guess. While there have been both positive outcomes and continuing opportunities for improvement, we can be certain that whatever national healthcare policy changes percolate out of Washington, the shift from fee-for-service to value-based care will continue and is likely accelerate.
What should patients, payers, manufacturers and prescribers be prepared to demonstrate as proof of their contribution to value-based care? Is the day coming when manufacturers only get paid for manufacturing costs of breakthrough therapies until their real world efficacy is proven?
When more than $300 billion in U.S. healthcare spending is wasted due to medication non-adherence, something’s got to give. We are eager to hear what healthcare leaders have to say about their value-proposition to the continuum of healthcare stakeholders.
Marc O’Connor is chief operating officer forCurant Health. Curant Health treats patients nationwide through its medication management protocols.