outcomes-based measurement in healthcare

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June 2014 Outcomes-based measurement Redefining our approach to adherence AN EPSILON PERSPECTIVE HEALTHCARE

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Page 1: Outcomes-Based Measurement in Healthcare

June 2014

Outcomes-based measurement Redefiningourapproachtoadherence

A N E P S I L O N P E R S P E C T I V E

HEALTHCARE

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Introduction3

Theimportanceofhealthoutcomes4

Outcomes-basedmeasurement5

Redefiningadherenceprograms6

Epsilonrecommendations6

Conclusion7

Contents

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Andinmostcases,wemeasurethesuccessofourpromotionalspendingandtheseprogramsintermsoftheirabilitytoensurethatpatientscontinuetofillscripts—whichwetakeasaproxyforadherencetotherapy.

Asapharmaceuticalindustry,wecollectivelyspendbillionsofdollarspromotingtherapiestopatientstostimulateinterest,intent,andongoingproductuse.Weruntelevisionads.Welaunchbrandedanddisease-awarenesswebsites.Wecreatecomplex,multichannelrelationshipmarketingprograms.

Introduction

Butintoday’schanginghealthcareenvironment,itisbecomingincreasinglyimportantforustotakeabroader,morepatient-centricviewofsuccess—onebasedonourabilitytoprovidebetterpatientcare,lowercosts,andimprovepatientoutcomes.

16%

37%

of health insurers have adopted new payment and contracting arrangements such as outcomes-based payments, risk-sharing agreements and bundled payments with pharmaceutical companies.

of those who haven’t adopted new payment and contracting arrangements are expected to adopt them within the next three years.

PwCHealthResearchInstitute(HRI),2012

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The importance of health outcomes

Healthcareoutcomesarebroadlydefinedaschangesinapatient’shealthstatusthatcanbeattributedtothecareheorshereceived.Achievingpositivepatientoutcomesisthefundamentalpurposeofhealthcare.

Traditionally,outcomes-basedinitiativeshavebeenthefocusofprovidernetworks,whichtodayarebeingdrivenbypolicyandpayersaliketowardperformance-measurementsystems.NewplayerssuchasAccountableCareOrganizations(ACOs)areofferingincreasingincentivestoprovidequalitycareandbetteroutcomes—anddisincentivesforfailingto.Proponents

arguethatthesesystemsdiscourageunnecessarytreatments,keeppeoplehealthier,andreduceoverallcosts.

Thepaceofchangeinthehealthcaremarketisaccelerating,andthereisgrowingpressureonallstakeholders—healthcaresystems,payers,policymakers,prescribers,andpharmaceuticalcompaniestofocusonvalue-basedhealthoutcomes.

Whilesalesandvolumewillcontinuetobekeyfinancialsuccessmetricsforin-linepharmamarketers,outcomeswillrapidlybecometheyardstickforhowtheindustryasawholeisperforminginimprovingpatienthealth.Healthoutcomeswillalsoincreasinglydriveformularyaccess,pricing,andreimbursementdecisions.

Theabilitytoprovetopatientsthattheyaremorethanascript,todemonstratepositivepatientimpacttohealthcareproviders,andtoshowpayersthatabrand’svalueextendsbeyondtheclinicalbenefitsofthedrugwillbethekeystosuccessforpharmamarketersinthisoutcomes-basedworld.

McKinsey,2013

Outcomes-based payment can reduce known sources of waste and inefficiency (redundant care, misuse, etc.), resulting in 10% or greater decrease in targeted spending.

Merck agreed to peg what the insurer Cigna pays for the diabetes drugs Januvia and Janumet to how well Type 2 diabetes patients are able to control their blood glucose. In return, Merck got better placement for Januvia and Janumet on Cigna’s formulary.

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Outcomes-based measurement

Movingtowardanoutcomes-basedapproachrequiresthatpharmatakeadifferentviewofmeasurement.Companiesmustdefinethekeyoutcomesagainstwhichtheywillmeasuresuccess;identifypracticalandreliablemethodstoaidcomparisons;anddeveloproutinereportstoshowcaseresults.Andfordrugsindevelopment,theywillneedtoidentifytherelevantmeasuresearlyenoughtoincorporatetheminPhaseIII/IIIbtrialdesigns.

Primaryoutcomesmeasuresmayincludetotalhealthcarecosts,incidence/prevalenceofparticulardiseasestates,ratesofspecifieddiagnostic/therapeuticprocedures,hospitalizationrates,andproductivityand

qualityoflifemeasures.Thesemaybedeterminedbasedonthetypeofcondition(e.g.,chronicvs.acute)andtheintentoftheprogram(e.g.,primaryvs.secondarypreventionvs.generalwellness).Coredataforthesemeasureswillneedtobederivedfromacombinationofproprietaryandthird-partysourcesincludingself-reportedpatientsurveys,medicalclaims,andprescriptionsources.

Thelevelofrigorappliedtoprogramevaluationshouldbalancefeasibilityandcost.Arandomizedcontroltrial—gold-standardforclinicalresearch—isnotalwayspossible.Ataminimum,wemustensurethatwearecollectingpatient-levelinformationandmeasuringagainstacomparisongrouporbaselinemeasure.Wemustalsoconsiderthedurationofmeasurement—typicallyin12-monthincrements—andplanaccordingly.MEDICAL CLAIMS

QUALITY OF LIFE

PATIENT SURVEYS

PRESCRIPTION SOURCES

HEALTHCARE COSTS

DISEASE-STATE INCIDENCE

DISEASE-STATE

PREVALENCE

DIAGNOSTIC

PROCEDURE RATES

THERAPEUTIC

PROCEDURE RATES

HOSPITALIZATION RATES

HOSPITALIZATION

PRODUCTIVITY

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Redefining adherence programs

Sohowdowemovetowardanoutcomes-basedapproach?Westartbyaskingsomesimplequestions:

•Areourprogramstrulydesignedtoimproveapatient’shealth?

•Arewehelpingpatientsunderstandtheriskfactorsassociatedwiththeirconditions?

•Areweprovidingtargetedinterventionsdesignedtostimulatepositivehealthbehavior?

•Doesparticipationinourprogramresultinbetterhealth,lowerhealthcosts,andincreasedproductivityandqualityoflife?

Ifwecan’tanswerthosequestionswitharesounding,“Yes!”thenwehavesomeworktodo.Thechallengeisnotinsurmountable,butitdoesrequireashiftinperspectiveandanewtoolset.

In 2011, Cigna initiated a partnership with EMD Serono designed to reduce relapses in MS patients—adverse events that cost the health plan up to $11,000 per hospitalization. Cigna/EMD are tracking the percentage of hospitalization and emergency room visits avoided by people using Rebif to convincingly demonstrate that any increased drug spend is offset by improved clinical outcomes and decreased costs-to-treat.

Develop a health assessment strategy. Allowpatientstobetterunderstandtheircurrenthealthstatusandtoidentifypotentialnear-andlong-termhealthrisks.

Create a risk stratification plan.Grouppatientsintomeaningfulrisk-basedcategoriesthatallowtheprogramtotargetrelevant,timely,andactionablecontent,toolsandresources.

Design segment-specific health management intervention tools. Helppatientsunderstand,navigate,manage,andcoordinatethehealthcareresourcesavailabletothem,andenablethemtobecomeproactiveandengagedmanagersoftheirownhealth.

1

2

3

Planningforanyoutcomes-focusedprogramshouldincorporatethreecriticalpillars:

Epsilon recommendations

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Conclusion

Amountingbodyofevidencedemonstratesthatpatientswhoareactively engagedintheirownhealthcarewillexperiencebetteroutcomesandincurlowercosts.

Activeengagementincorporatestwokeyconcepts:

•Thepatient’swillingness and abilitytomanagehisorherownhealthandcare,and

• The empowermentofthatwillingnessandabilitywithtargetedinterventionsdesignedtopromotepositivepatientbehavior.

Ifwecanmaketheshifttothinkingaboutadherenceprogramsastoolstoenablethegoodofpatients—notjusttosecureadditionalrefills—wewillbeablenotonlytomeasureoursuccessinimprovedhealthoutcomes,buttomeetthenewchallengesofourchanginghealthcaresystem.

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Epsilonisthegloballeaderincreatingcustomerconnectionsthatbuildbrandandbusinessequity.Anewbreedofagencyforaconsumer-empoweredworld,ouruniqueapproachharnessesthepowerofrichdata,world-leadingtechnologies,engagingcreativityandtransformativeideastoigniteconnectionsbetweenbrandsandcustomers,deliveringdramaticresults.Recognizedby

ByBruceGrant,SVP/Strategy,EpsilonHealthcare

A veteran with more than four decades in healthcare marketing and digital business strategy, Bruce currently serves as Senior Vice President of Strategy for Epsilon’s Healthcare Portfolio. In this capacity, Bruce offers evidence-based strategic counsel to Epsilon clients, internal teams, and partner companies, as well as development of new offerings to meet the changing needs of healthcare marketers.

AdAgeasthe#1U.S.AgencyfromAllDisciplines,#1WorldLargestCRM/DirectMarketingNetworkand#3LargestU.S.Digital-AgencyNetwork,weemployover5,000associatesin60officesworldwide.EpsilonisanAlliance Datacompany.Formoreinformation,visitwww.epsilon.com,[email protected].

About Epsilon

Our approachCreating effective connections that drive tangible business results

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