In reading a recent article published by PharmaExec on Innovative Contracting, http://blog.pharmexec.com/2012/07/25/innovative-contracting-whats-the-verdict/, it was encouraging to see continued discussion within Life Sciences arena that strives to address the needs of their customers, the payers and providers.
Payers and providers are both taking on significantly more risk with the Affordable Care Act. Life Sciences can have a role in sharing both the upside and downside associated with the new pay for performance models defined by the act. However, it will require more than new contracting models.
The three contracting models start to address sharing in the risk of reimbursement and decreasing costs.
However, why should the innovation stop at the point of these three contracting models or even at contracting overall? Isn't there an opportunity to develop deeper collaborative partnerships that are focused on 1.) the patient, 2.) the patient's outcomes, and 3.) decreasing the total-cost-of-care.
For instance, what about "services wrappers" with which life sciences companies could surround their brands? Service wrappers that would deliver unbranded education and patient support irrespective of the brand that a patient is prescribed.
The current approach of every brand offering its own patient services creates complexities for providers in ensuring their patient is signed-up with the correct "branded" program. Given the number of patients, diseases conditions, and treatment options, the idea of brand specific support services could, and has led to hundreds of different patient support programs, which are neither cost effective nor easy for the provider to stay abreast and ensure every patient is enrolled in the "branded" program.
Contracting would still have an important role in broader unbranded patient support programs. If a patient was prescribed a competitor's brand AND placed on another life sciences company's support program, the plan or provider would reimburse the life sciences company for the cost of the program at a pre-determined price. If a patient was prescribed the life science company's brand and placed in its program, the plan or provider would be reimbursed at a variable price of the branded product based upon patient outcomes.
Life science companies have spent decades understanding the needs, attitudes and behaviors of patients. These insights enable relevant messaging and sustained engagement with patients. Now, imagine if programs were developed that leveraged real-time data EHR, from the provider and payer and the insights from life sciences companies around the patient attitudes, needs, and behavior. In the future, first diagnosis could lead to immediate engagement with a health coach; bi-weekly peer patient support group meetings with a clinician; pro-active follow-up on tests/future office appointments, refills reminders, and remote monitoring. Additionally, how about continual reassessment of the patients risk for disease progression or a critical care event such that limited support resources could be directed to those patients that would benefit most from support interventions.
Yes, this would require new approaches to data sharing in a HIPAA compliant manner and it would require contracting for both Value-added Agreement and a Performance Based Agreement simultaneously. It would require the parties to leverage new analytic capabilities to identify which patients are most at risk as well as those patients that would benefit most.
Many of the challenges that previous article identified will still exist - administrative burden associated with tracking contract performance, aligning on end-points for reimbursement, and building partnership trust. Others challenges will diminish with the formation of ACOs that take on the role of payer and provider with a comprehensive view to patient administrative and clinical data.
If all parties focus on the patient, the patient's outcomes, and decreasing the total cost of care for their patients, everyone is positioned to succeed. However, it will require new approaches to contracting, service offerings and collaborative partnerships with all the partners in healthcare.
The benefits to all parties are there. The challenge is realizing them.