Value-Based Healthcare. The Idea? Not New. Actually Making Happen? That Might Be | Asembia 2024

Value-based care and contracting have been discussed for years in specialty pharmacy circles but there is a gap still between the talking and the doing.

Optum executives and the head of Takeda Pharmaceuticals inflammatory bowel disease (IBD) discussed how they are injecting some reality into the idea of value-based healthcare at the 2024 Asembia specialty pharmacy meeting in Las Vegas.

“The concept is not new. The way we can operationalize it is new,” said Olivia Banyon, M.P.H., vice president, clinical enterprise programs, at Optum Life Sciences, which is part of the unit at Optum that provides data analytics and managed care services.

Banyon and Sean McCabe, MBA, vice president, inflammatory bowel disease franchise head at Takeda, discussed what is important in a partner in value-based care, and Banyon provided a general overview of the process they are using. Erin Hulbert, MBA, director, value-based contracting at Optum Life Sciences, moderated the session, which was held Monday morning.

Takeda makes and markets Entyvio (vedolizumab), a treatment for ulcerative colitis and Crohn’s disease, the main forms of IBD. Entyvio was approved by the FDA in 2014, but Takeda received the OK for a subcutaneous version for Crohn’s disease only last week and for ulcerative colitis, last year. The subcutaneous version faces stiff competition in Stelara (ustekinumab) and Skyrizi (risankizumab).

Banyon said developing a value-based care program requires a partner who can adjust to unexpected problems and the challenges involved in dealing with patients and providers in the real world outside. “It is messy," she said.

Banyon also said partners in value-based care collaorations need to be ready to ask novel questions because the problems the arrangements pose are often in uncharted territory.

Implementing value-based care means not focusing on just one point in time, Banyon said, but on the entire patient journey.

“When a patient does get hospitalized, what type of data and what kind of care system follows that patient out of the hospital for a care management perspective back to the Optum care network?” Banyon asked rhetorically.

Banyon said timely data is key to following patients and taking responsibility for entire range of their care.

“But it's not just the data,” Banyon continued. “It’s how that data is communicated to that provider and whether or not that provider is able to use it. And when I say providers, [it is] the whole care team — it is the physician, it is the specialist, the pharmacists and nurses, the case managers, integrated, across the system.”

Banyon also mentioned “patient journey gaps”and challenging of managing inflammatory bowel disease, an umbrella term that includes Crohn’s disease and ulcerative colitis, because the symptomatology is highly variable.

“Why aren’t they coming in and getting the care that they need? We're asking these questions,“ she said. “Is it because we are not providing enough care? Is there not enough access to care when the patient needs care, because you can't predict when a patient needs the care — when a person has a flare up? We can't predict when that's going to happen.”

Banyon thumbnailed a four-step process that Optum is using to implement value-based care that starts with an analysis of the patient population that looks for variability of care at the patient and provider level. The next steps include process analysis, design sessions with collaborators and considerations of the “operational lift,” selection of the appropriate operational and outcome metrics and then analysis of results according to those metrics, baseline comparisons and further refinement of the program.

McCabe noted that Takeda, a 243-year-old Japanese company, has a culture that favors taking a long-term view, which is consistent with implementing value-based care. He referenced the company’s “PTRB” values: putting the patient first, building trust, reinforcing reputation, and developing a sustainable business. He also spoke about the company’s expertise in IBD and insights into suboptimal patient journeys. McCabe said it was encouraging to go beyond just expertise and data analysis and partner "with an organization that is willing to do something about it.”