Defining and measuring value in healthcare has been a focus for both payers and manufacturers for a number of years, and this theme continued during the 2019 AMCP Annual Meeting.

What used to be separate conversations between the various entities involved in delivering and paying for healthcare has evolved into a more collaborative approach. Discussions now take into consideration multiple stakeholder perspectives, including patients, provider groups, manufacturers, and payers. In the session titled Using Rapid Cycle Analytics of Real-World Data to Manage High Risk, High Cost Patients, the presenters discussed the roles of providers, payers, and manufacturers to support optimal formulary management and deliver better patient care. One key learning they noted was the realization that one size does not fit most when it comes to interventions to support improved care delivery. Infrastructure, data limitations, and population differences are just some of the reasons that were cited in preventing the broad-scale implementation of a single solution for value-based care.

Often, it’s because of these barriers that value-based contracting is not as prevalent as stakeholders would expect. In the session titled The Current State of Value-Based Contracting, Dr. Kenney outlined a 5-step process to support the design and implementation of value-based contracts in light of the roadblocks that were discussed in many of the sessions. This process creates opportunities for manufacturers and payers to engage in multiple conversations in an effort to understand the options available to account for data collection and measurement limitations. He also highlighted the need for multi-stakeholder collaboration and aligned incentives to support contract finalization.

Collaboration and alignment continued to be key themes in sessions devoted to gene therapy. Experimenting with alternative payment models for gene therapies is of great interest due to the high upfront cost and benefits from therapies that often last multiple years or indefinitely. In the various payment models discussed, aligning on appropriate clinical outcomes and the timing associated with those outcomes are critical.

A key takeaway from the meeting for manufacturers is that interest in value-based contracting to support measuring a product’s value is not going away. Although the barriers are well known, payers continue to look for opportunities to engage in these agreements and are implementing the lessons learned and shared during AMCP and other forums in their own organizations. Manufacturers should think creatively about mutually beneficial outcomes measures and be prepared to respond to requests for alternative payment model as they arise.