Linking payment to health outcomes: A taxonomy and examination of performance-based reimbursement schemes between healthcare payers and manufacturers

Carlson, Josh J.; Sullivan, Sean D.; Garrison, Louis P.; Neumann, Peter J.; Veenstra, David L.

doi:10.1016/j.healthpol.2010.02.005

Cited by 241 publications

(246 citation statements)

References 16 publications

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“…In some cases, innovative access with evidence development or "performance-based risk sharing" agreements have been used (28). These have been discussed extensively in previous Policy Forum meetings and elsewhere (although the focus in many of those discussions has been more on value than affordability) (18).…”

Section: Rethinking Value Affordability and Access Theory And Princmentioning

confidence: 99%

Changing Health Technology Assessment Paradigms?

Husereau¹,

Henshall

Sampietro-Colom³

et al. 2016

Int J Technol Assess Health Care

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Objectives: Health technology assessment (HTA) has to innovate to best support changing health system environments and to help provide access to valuable innovation under fiscal constraint. Methods: Issues associated with changing HTA paradigms were identified through scoping and explored through deliberation at a meeting of industry and HTA leaders. Results: Five broad areas of change (engagement, scientific dialogue, research prioritization, adaptive approaches, and real world data) were identified. The meeting focused on two themes derived from these: re-thinking scientific dialogue and multi-stakeholder engagement, and re-thinking value, affordability, and access. Earlier and ongoing engagement to steer the innovation process and help achieve appropriate use across the technology lifecycle was perceived as important but would be resource intensive and would require priority setting. Patients need to be involved throughout, and particularly at the early stages. Further discussion is needed on the type of body best suited to convening the dialogue required. There was agreement that HTA must continue to assess value, but views differed on the role that HTA should play in assessing affordability and on appropriate responses to challenges around affordability. Enhanced horizon scanning could play an important role in preparing for significant future investments. Conclusions: Early and ongoing multi-stakeholder engagement and revisiting approaches to valuing innovation are required. Questions remain as to the most appropriate role for HTA bodies. Changing HTA paradigms extend HTA's traditional remit of being responsive to decision-makers demands to being more proactive and considering whole system value.Keywords: Health technology assessment, Patient participation, Stakeholder engagement, Financial management, Value-based purchasing Often, the purpose of health technology assessment (HTA) is to inform decisions about the coverage/reimbursement and use of new and existing health interventions, typically within health systems with limited resources to acquire and deliver them (1). HTA should be tailored to the types of decisions it is informing and reflect the needs and realities of the health and innovation systems within which it is operating. This is reflected in a growing recognition that it should take account of the lifecycle of health system innovation to be more impactful (2;3).In recent years, there have been fundamental changes in approaches to health system delivery, influenced by increasing public demand and patient influence, limited resources, new governance models, developments in information and communication technology, and new service delivery models seeking to improve quality and efficiency (4). Commercial innovators have similarly created new approaches to technology development, exploiting scientific advances, and working more closely with health system regulators and administrators to develop the evidence of safety and effectiveness that they seek (5).The Health Technology Assessment internatio...

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Section: Rethinking Value Affordability and Access Theory And Princmentioning

confidence: 99%

Changing Health Technology Assessment Paradigms?

Husereau¹,

Henshall

Sampietro-Colom³

et al. 2016

Int J Technol Assess Health Care

View full text Add to dashboard Cite

show abstract

“…Alternatively, financial risk and responsibility could be shifted to drug companies in the form of value-based pricing or performance-based reimbursement [22][23][24][25]. As a hypothetical example, if a drug company's research showed a six-month median gain in overall survival for its drug, then it would receive only 10 percent of the drug price for patients whose survival gain was less than three months, 20 percent for less than six months, and full price for those who exceeded that six-month gain.…”

Section: Some Policy Options Some Practice Optionsmentioning

confidence: 99%

How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments?

Fleck

Danis

2017

AMA Journal of Ethics

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Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many partiesmedical scientists, reviewing agencies, insurers, and accountable care organizations-can and should contribute to optimizing the development, approval, funding, and prescription of therapiesparticularly expensive and marginally beneficial therapies. In aggregate, they should aspire to achieve a pattern of fair, cost-effective therapeutic decisions to ensure a sustainable health care system. Here we offer some suggestions regarding decisions that physicians might pursue to facilitate fair and cost-effective patient care. CaseDr. C sits on a committee as part of his tertiary care center's accountable care organization (ACO) that is considering whether a new biologic, Expensivimab, should be included in the organization's bundled treatment plan for its patients. Expensivimab is a new humanized antibody that targets an apoptotic receptor. One study suggests that it increases tumor-free survival in late stage non-small cell lung cancer (NSCLC) by a median of six months relative to a drug approved several years ago. Another suggests that it increases overall survival by a month-and-a half relative to the same drug. Yet no research on the comparative effectiveness of Expensivimab relative to other interventions for NSCLC exists, and even data on the risks of Expensivimab relative to the older drug is scant.Furthermore, assessing Expensivimab's cost-benefit ratio is difficult. Although Expensivimab costs $750,000 per patient, the United States Food and Drug Administration (FDA) did not request any data on trial participants' perceptions of their quality of life. Hence, no assessment of quality-adjusted life years (QALYs) or disability-

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“…For new medicines we see reimbursement and market access conditioned upon indicators of outcome [17]. It may only be that data about patient characteristics are requested to satisfy that the drug is correctly used, but there are also examples where payment is related to response or even final outcome.…”

Section: Relative Effectiveness and Variations In Access To Medicinesmentioning

confidence: 99%

Relative effectiveness and the European pharmaceutical market

Jönsson

2011

Eur J Health Econ

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Linking payment to health outcomes: A taxonomy and examination of performance-based reimbursement schemes between healthcare payers and manufacturers

Cited by 241 publications

References 16 publications

Changing Health Technology Assessment Paradigms?

Changing Health Technology Assessment Paradigms?

How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments?

Relative effectiveness and the European pharmaceutical market

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