Stakeholders across the healthcare system are looking to value-based care models to improve healthcare outcomes and quality while decreasing overall costs. While a shift from a fee-for-service (FFS) to a value-based model has potential benefits for patients, payers, and providers, this transition will require significant changes in how healthcare is delivered, measured, and paid for. The Centers for Medicare & Medicaid Services has developed several APMs, including the Medicare Shared Savings Program, accountable care organization (ACO) model, Oncology Care Model (OCM), and Hospital Value-Based Purchasing (VBP) Program to incentivize providers and health systems to improve outcomes for the populations they manage. As providers take on risk within these payment models, they are also evolving their care delivery processes to support performance in these arrangements and support improved care and efficiencies in the process, primarily through patient-centered care and effective use of technology.
Many providers are focusing on holistic, patient-centric care strategies to support improved quality performance and patient outcomes. Patient-centered medical homes (PCMHs) are an example of a model that drives a coordinated approach by integrating care across healthcare providers and specialties. Additionally, the use of a multidisciplinary team can include regular assessment and support for needs outside of chronic condition management, including mental health services and social determinants of health (SDOH). Addressing or mitigating social and financial challenges can improve patient access to care and adherence with prescribed medications. The socioeconomic needs of many patients are complex and multifactorial; as a result, providers and health systems are seeking different opportunities for partnerships, including with pharmaceutical manufacturers and payers, to tackle these issues from multiple angles.
Another aspect of patient-centric care is effectively engaging the patient in the treatment decision-making process. The shared decision-making model incorporates the patient into the treatment decision-making process and acknowledges their specific preferences and concerns. Use of shared decision-making has been associated with improved patient satisfaction and health outcomes, which are both important measures in a value-based care model. As use of shared decision-making increases, manufacturers should consider what aspects of their products or portfolios may be preferred by patients, such as route of administration, convenient dosing regimen, or a more tolerable side-effect profile. Additionally, many providers are looking for support as they incorporate shared decision-making into their current workflow. Manufacturers may want to consider creating above-brand, patient-facing educational materials to facilitate provider-patient discussion on various options.
Patient-reported outcomes (PROs) are increasingly recognized as an important metric in support of both patient-centric care and value-based care, as stakeholders look to “measure what matters” to determine both patient outcomes and patient satisfaction/experience. Value-based reimbursement models, such as the upcoming Oncology Care First (OCF) model, have incorporated PRO reporting as part of their program requirements. As healthcare stakeholders gain additional comfort and visibility with PROs, it may increase interest in data describing treatment impact on PROs. Manufacturers should consider collecting and communicating PRO data in both clinical trial and real-world settings to better describe the humanistic impact of treatments.
Effective use of health information technology is a key component to supporting both a patient-centric approach and value-based care. Electronic health records (EHR) can facilitate documentation and communication of care plans, procedures, and diagnostics across a multidisciplinary team. EHRs can also be utilized to support standardization of evidence-based protocols and pathways for a given condition, which may also improve performance in value-based reimbursement models. While most providers and health systems utilize an EHR system, they may benefit from support tools that maximize their use of the EHR to help meet their overall goals and metrics. Manufacturers can consider development of tools such as build guides for evidence-based protocols, patient identification programs, or pursuit lists for providers.
Telemedicine and remote monitoring present additional opportunities to leverage technology to support improved patient outcomes. These methods can be particularly helpful for certain populations where there may be greater distance to providers (eg, rural areas), or in conditions where patients have inherent barriers to traveling to a physician office (eg, conditions affecting an elderly population or associated with accumulation of disability). Use of technology to support more frequent patient communication and monitoring may lead to increased opportunities to identify patients for a new treatment, increase/decrease dose, monitoring for side effects, or need for a medication switch. Manufacturers may want to consider identifying and communicating case studies on how these technologies have been successfully used to optimize treatment, improve outcomes, and support patient satisfaction.
- NEJM Catalyst. What is value-based healthcare? https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558. Published January 1, 2017. Accessed October 14, 2021.
- Mcaskill R. Examining the fee-for-service v. value-based payment models. Xtelligent Healthcare Media. https://revcycleintelligence.com/news/examining-the-fee-for-service-vs-value-based-payment-models. Accessed October 14, 2021.
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