Value-Based Agreements Should Start Small and Simple, Say Stakeholders at AMCP Partnership Forum

Alexandria, Va., Nov. 20, 2018 — Health care stakeholders aiming to advance the concept of value-based care models should start with small, simple initiatives to help ease compliance and legal concerns, suggested attendees of a recent Academy of Managed Care Pharmacy (AMCP) Partnership Forum on establishing value-based agreements for pharmaceuticals in integrated delivery networks (IDNs).

Maintaining a certain level of risk tolerance, as well as buy-in from top leadership, is important in moving value-based models forward, according to the more than 40 health care thought leaders attending the Nov. 13-14 event in Baltimore, Maryland. Attendees suggested starting with simple value-based agreements with clearly obtainable goals to allay risk concerns.

Value-based care models are designed to support payment based on improved outcomes rather than volume of care provided. AMCP has taken a leading role in advancing the concept, which has potential to improve quality of patient care and lower costs. Previous Partnership Forums have examined different aspects of value-based care. The November Partnership Forum explored issues around establishing value-based agreements between biopharmaceutical companies and IDNs.

“Nowhere is the potential and challenge of value-based care more evident than in integrated delivery networks,” said AMCP CEO Susan A. Cantrell, RPh, CAE. “By their very design, IDNs have the necessary infrastructure in place to capture data on whether a patient or group of patients obtained a desired therapeutic outcome through an intervention. In other words, IDNs collect the data necessary to determine value in care.”

But first, IDNs must overcome significant operational hurdles. Successful adoption of value-based agreements require many complex processes to occur, including advanced data analytics, end-to-end population health management solutions, comprehensive care management, and successful patient engagement. Forum attendees focused on issues such as understanding: 

  • How value-based care is currently delivered in IDNs; 
  • Opportunities and barriers to implementing pharmaceutical value-based agreements; and
  • Opportunities for managed care organizations, accountable care organizations and IDNs to collaborate to drive improvements in health care outcomes. 

Attendees noted the growing prevalence of value-based agreements in IDNs around population health initiatives, such as boosting medication adherence, rather than around specific products or reimbursements. But others noted that many agreements may be underreported, and overall the concept is still emerging. Legal and compliance concerns are among the hurdles slowing adoption of value-based agreements.

A need exists for regulatory safe harbors, as well as transparency to ensure all parties are equal stakeholders, the attendees noted. Another crucial element is to have templates of principles for value-based agreements, which could assist with greater adoption and execution. Attendees noted that AMCP can play a pivotal role by soliciting and gathering ideas from varied stakeholders, and providing education and best-practices necessary to increase adoption of the agreements.

As with all of AMCP’s Partnership Forums, attendees represented a range of stakeholder perspectives, including patients, payers, providers, government and biopharmaceutical companies. The event was made possible with support from Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, Lilly, MedImpact, Merck, National Pharmaceutical Council, Novo Nordisk, the Pharmaceutical Research and Manufacturers of America, Takeda, and Xcenda. A proceedings document on the Partnership Forum will be published in an issue of the Journal of Managed Care & Specialty Pharmacy (JMCP) in first quarter next year.