outcomes-based measurement in healthcare
TRANSCRIPT
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.
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2
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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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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.
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