In value-based healthcare, insurance reimbursements depend on the quality of outcomes. It isn’t exactly the “no win, no fee” model of accident and injury lawyers, but one key aim is certainly to clamp down on escalating cost. In this model, companies such as pharma companies and medical device manufacturers are rewarded for better outcomes (or lower cost) – and paid less when therapies are not as effective as expected.
Although adoption is being driven primarily by the payers, value-based care is an opportunity for all stakeholders – life sciences companies, providers, payers and patients – to improve both financial and health outcomes.
Value-based care as a concept originated in the USA, but has generated interest worldwide. In Europe, traditionally highly regulated healthcare markets are moving from a fee-for-service to performance-based models in which outcome risks are shared between payers and life sciences companies such as pharmaceutical providers. Sweden, with its interconnected registries and e-health records, is a leader in value-based care. The UK’s National Health Service launched its Quality and Outcomes Framework back in 2004. In Switzerland also, value-based care is on the agenda, with policymakers now conducting Health Technology Assessments (HTAs) to evaluate medical procedures and technologies. Swiss healthcare is viewed as excellent – and expensive. Value-based care has the potential to maintain excellence while reducing cost all round.
Three success factors with digital platforms
For value-based care to work, stakeholders need seamless digital platforms and frameworks to gather, store and present anonymized intelligence from researchers, insurers and medical records, as well as from digital devices such as mobile apps and wearables.
Tech platforms can drive success in three key ways:
- Channel real-world evidence into R&D investment decisions and use it to evaluate economic and competitive factors before embarking on development or clinical studies.
- Design and administer outcomes-based pricing: networked platforms provide a robust basis for defining how risk and reward will be shared fairly between payers, life sciences companies and other stakeholders to meet the aims of value-based care.
- Measure and inﬂuence patient outcomes: with powerful systems and platforms to transform raw data into intelligence, stakeholders will be able to channel this information into solutions to improve patient outcomes.
Value-based care is already here – and the digital transformation to enable these new models is underway. To learn more, read our white paper Value-Based Care in Life Sciences: The Role of Digital Platforms.