Navigating the Value-Based Paradigm: A Health Spoken Here Series

5/21/2018 Navigating the Value-Based Paradigm: A Health Spoken Here Series

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August 2014
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The fir st of the health spoken here fo rums was held onMay 27, 2 014 at ghgs New York headquarters. The eventinvited several professionals within different fields ofhealthcare, including J.D. Kleinke, Health Care BusinessStrategist, Lynn OConnor Vos, CEO of ghg, Lindsay Farrell,President and CEO of Open Door Family Medical Center,Bill Meur y, Executive Vice President Commercial, NorthAmerican Brands, Actavis, Laurel Pickering, Presidentand CEO of Northeast Business Group on Health, andDr. Nancy McGee, Managing Director of Manatt Health

Solutions, Inc.

In this discussion about the changing environmentof healthcare, each partic ipant provided differentperspectives on key topics, including accountability,new health technology, the shift towards patient value,among others. Attendees of the forum, includingemployees of ghg and clients, al so played an integral roleas they were invited to take par t in this dynamic forum.

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J.D. Kleinke, ModeratorHealthcare Business Strategist

Lynn OConnor VosCEO, ghg

Laurel PickeringPresident and CEONortheast Business

Group on Health

Lindsay FarrellPresident and CEOOpen Door Family

Medical Center

Bill MeuryEVP Commercial

North American BrandsActavis

Dr. Nancy McGeeManaging Director

Manatt HealthSolutions, Inc.
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The health spoken hereseries is a thought-leadership platformseeking to engage customers and companies in the healthcareconversations that matter. The fact is, the healthcare landscape iscontinuously evolving and all players involved are seeking ways toaddress the new paradigm.

Central to the health spoken here series are events tailoredto address issues of healthcare, and its primary stakeholders consumers, payers, healthcare professionals, and the overallhealthcare community. The events, ranging from panel discussionsto innovation development, offer a comprehensive platform toaddress the key issues, challenges, and opportunities within theshifting healthcare landscape. Hosted by ghg, the health spokenhere series allows us to speak about health in new ways. Thiskeeps our stakeholders abreast on the topics that matter to themthe most, while delivering meaningful engagement and impactfulopportunities to learn. This document summarizes the proceedingsof the event.

About health spoken here


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But with US healthcare dynamics propelled by a myriadof stakeholders, even just the notion of defining valueis both complex and challenging. The multiplicity ofinfluencers, decision-makers, and real-world participants

in the healthcare conversation brings with it wide-ranging definitions of value, each driven by stakeholdersown perspectives, needs, and objectives. Across a diversehealthcare landscape, assessing the value constructpresents a curious dichotomywhere you standdepends on where you sit.

In the latest instal lment of ghgs health spoken hereseries, key stakeholders from across the US healthcarespectrum debated how the ACA could c hange the waythe healthcare system determines value or whether the

reforms are just a rehash of old polic ies. Their accountswere compelling.

As always, diverse views clearly reflected whereindividual participants sit in todays new health economy.But equally clear was the need to stand together inalignment if the wider goal of value-based and affordablecare for all is to be achieved.

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The concept of delivering valuelies at theaspirational heart of the Affordable Care Act (ACA) and its a simple, and indeed laudable, goal.


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A central tenet of the ACA is the aim to curb the rising cost of healthcarein the US and to make providers across the care conti nuum moreaccountable for the cost, q uality, and value of what they deliver. Its asingular aim, but responsibility for delivering it has been placed in thehands of an historically disparate and disconnected set of stakeholders.

This r ich tapest ry encompasse s a ll the usual susp ect s: prov iders,physicians, health insurers, exchanges, employers and, of course,pharmaceutical and medical device manufacturers. But dig deeper, andit also extends to subgroups such as pharmacists, nurses, paramedics,dentists, care coordinators, and public heal th professionals. In the middleof it all, though too often peripheral to the discussion, are the patients,

caregivers, and consumers but their voices are getting louder. So thequestion is simple: with so many players and so many perspectives tobalance, can one piece of legislation rebuild the service to create a healthdelivery system that is fit and affordable for all? Or are the politicalcarpenters really just building Yesterday Once More?

The long-term goal of ACA is to del iver value-based, pat ien t-centrichealthcare. But in a redesigned system that, critics argue, still promotesperverse incentives and has competing interests, how can healthcarestakeholders unite to drive value? And how, in a wider environmentdriven by the simultaneous need for c ost containment and innovation,can players across the continuum demonstrate the value of theirproducts and services to deliver the much-theorized valueequation? Moreover, how can we separate the reality from therhetoric? Its time for some real-time, real-world thinking.


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would be easy to conclude that theres astrong sense of dj vuabout the latestattempts to reconfigure the US healthsystem. Weve been through much

of this before back in the era of managed care,

says medical economist and healthcare businessstrategist J.D. Kleinke. A lot of what is happeningtoday feels oddly nostalgic to that era arguablyonly the language has changed. For example,Medical Home? We used to call those primarycare providers. Accountable Care used to beknown as managed care, while Accountable CareOrganizations were called Integrated DeliveryNetworks. It all seems very familiar.

Small wonder then that J.D should use the artistformerly known as Prince to provoke the discussion.On the face of it, its easy to question whether the ACA

is any different, or whether were all just partying like

its 1999.

The multidiscipl inary consensus, however,is that the new legislation goes far beyondreinventing the wheel. Laurel Pickering,President and CEO, Northeast Business Groupon Health a not-for-profit coalition that helps

organizations purchase healthcare benefitsfor their employees believes the currentclimate and appetite for change sets it apartfrom the managed care era. Its very different.Stakeholders are aligned in this journeytowards accountable care in a way that wehavent previously seen not least becauseof the governance. A major componentof ACA is about driving down costs andincreasing value and we are now seeingpayers, providers, and all the otherstakeholders investing in moving thatagenda forward. We never saw that back in1999.

Party like its

1999It

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For once, it seems that this much-hyped alignment hasmoved beyond ideology and into reality. There is now a lotof skin in the game, says Nancy McGee, Dr.PH, ManagingDirector, Manatt Health Solutions, an interdisciplinary

law firm that works with pharmaceutical companies tohelp interpret the ACA and develop services to supporthealthcare providers. People have actually enrolled inexpanded Medicaid programs, and theyre enrolling inexchanges. Whats more, there are people who havecoverage now that never had it before. So this has becomevery real. It s happening. But there is still a large populationof people who now have coverage, yet still cannot affordtheir drugs. This is something that we need to addressweneed to look at how pharmaceutical manufacturers canhelp increase patient access to pharmacy products. Its

vitally important that everyone has access to healthcare.So now its just a case of applying those learnings from the1990s to what we are doing today. Its the most excitingtime in US healthcare.

Change, it seems, is clearly happening on the ground. Forsome stakeholders, advances in healthcare technologiesand informatics tools are helping to facilitate accountability,and accelerating moves towards the value-based paradigm.

Lindsay Farrell, President and CEO, Open Door FamilyMedical Centers a not-for-profit provider of healthcareand social services for low-income people, and also a newlyformed Accountable Care Organization says that todaysdata infrastructure alone makes the new healthcare modelso much different than the one from 1999.

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Te pharmaceutical industry hasobserved more change in the past 18

months than weve perhaps seen inthe previous 10-15 years.

Bill Meury, Executive Vice President Commercial,North American Brands, Actavis

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We have access to information that we never hadbefore - with robust health information systems andthings like meaningful use. That said, at Open Door, theintroduction of the new and innovative payment modelsthat accompanied ACA has not really bothered us its justmore of the same. When you work in the Medicaid spacethere is always a tremendous emphasis on accountability weve been sending data to Washington for a very longtime and have to go to Congress every year to secure and

justify our resources. His torical ly, weve not had access to alot of information across the continuum of care but now,thanks to the new transparent data infrastructure, were ableto use that information to show how we deliver value to ourcommunities Lindsay Farrell.

Despite the obvious progress, a degree of caution is stillrequired; the paradigm shift will not happen overnight.Its true that the current pace of change is differentfrom previous reforms, says Bill Meury, Executive VicePresident Commercial, North American Brands at ActavisThe pharmaceutical industry has observed more changein the past 18 months than weve perhaps seen in theprevious 10-15 years. Pharma companies are looking at theimplications the ACA will have on R&D and the licensing ofnew products, and theyre recognizing that they will needto look very carefully at the utility of new compounds in thefuture. The new system, even with the ACA, will still rewardinnovation, but there remains a question about whatmight be considered marginal innovation. So althoughthese changes are very real and theyre also, in fact, verymanageable there are many outstanding questions on theindustry side that will take several more years to answer.

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he drivers for change are clear and they are notconfined to the US. Globally, the combinationof aging populations and the sustainedincrease in patients with long-term conditions

is placing huge pressure on healthcare resources andforcing governments to introduce measures to curb thefar-reaching cost of disease. Similarly, efforts to deliveruniversal health coverage a trend across both developedand emerging nations present significant economicchallenges. In the US, attempts to move away from thetraditional Fee for Service model and instead re- engineeraround value are eminently sensible. But with the value-based economy recognized as a global direction oftravel, some commentators argue that the drive towardsaccountability carries a market inevitability, irrespective of

the legislation.

Laurel Pickering is less emphatic, but agrees that thechallenges of extended coverage have forced the marketto refocus. Moves towards accountability and value-basedhealthcare were always likely to happen but the ACA has

accelerated progress.

across the

UNIVERSET

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33%uninsured

57%uninsured

14%employer/cobra

16%non-groupplan

9%Medicaid

Previousinsurancecoverageamongthosewhopurchasedexchangeplans

Previousinsurance

coverageamongthos

e

whopurchased

non-exchan

ge,

ACA-compliantplans

30%employer/cobra

27%non-groupplan

7%Medicaid

Politically, delivery-system reform has dominated thedebate; there has been a major focus on things likecoverage issues, Medicaid expansion, and the exchanges.By comparison, the renewed focus on value a naturalby-product of the reforms has largely gone under theradar. But its really significant, not least from an employersperspective. For example, the excise tax - a core component

of the ACA is really driving employers to change theway they provide health benefits. The appetite for Feefor Service has gone; instead, insurers are increasinglyexploring new and innovative cost-sharing models. Wouldthis have happened without the ACA? Yes. But i t would havehappened much more slowly.

The clamor to eliminate Fee for Service is ubiquitous.Well, almost. Despite the resounding economic logic ofnewer models, a large number of providers still rely heavilyupon a traditional payment methodology. From a budgetperspective, scrapping Fee for Service makes a lot of sense but its easy to forget that a lot of our health systems arestill paid that way, says Dr. Nancy McGee. So how do weget to the value paradigm if it is a total paradigm shift?Pharmaceutical manufacturers need to remember thatoperationally, Fee for Service is how a lot of hospitals survive.Its going away, but its going to take time for that to happen.

Such complex dynamics are exemplified by Open DoorFamily Medical Centers, which as a provider and an ACO, has

feet in both camps. As a provider, Fee for Service still worksfor us from a management standpoint; it really translatesinto patient access. If we dont provide access for ourpatients, theyll leave us for a competitor that can give themaccess 24/7, says Lindsay Farrell. The ACO, however, givesus the opportunity to try innovative payment methods.Weve done this successfully before. Back in the 90s, wewere one of the few East Coast providers in a capitatedMedicaid model; we figured it out, and became muchstronger as a result. We anticipate similar learnings from theACO, because I expect all of our commercial contracts will

go that way sooner or later.

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So how do we get to the value paradigm

if it is a total paradigm shift?

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Obviously, its in providers interests to continue to be paidin the Fee for Service methodology. But outside that, itsin noone elses interests at all not even the consumers.In fact, healthcare really is the last industry to adapt. Fromthat standpoint alone, its going to be really importantthat healthcare providers adapt and change in the sameway that our supermarkets and banks have. We really mustprovide a better experience for our patients.

The emergence of ACOs is certainly challenging the oldmodel but progress is a marathon not a sprint and,according to Bill Meury, we are not even close to thefinish line. ACOs still represent a very small par t of theoverall market. Theyre doing great things and there aresome terrific principles being applied to delivering care,managing quality and reducing cost. But were a long wayfrom being done. Providers, pharmaceutical companies andall the other constituencies dont really know where this isgoing to end up. But one thing is certain: its complicated,and its going to take a lot longer to implement than mostpeople anticipate.

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how far have we come? In simple terms, not far enough. A major component of the ACA is to reduce the volumeand burden of avoidable hospital readmissions and place greater emphasis on disease prevention, primary caremodels, and the provision of value. But a recent study by the Catalyst for Payment Reform revealed that, in 2013,less than 11% of provider payments were value-oriented. Moreover, the latest federal records show that, despite

the governments campaign to reduce the number of patients readmitted to a hospital within one month, Medicare haslevied almost $500 million in penalties against poor-performing hospitals across almost every state. In relative terms,healthcare has made tremendous strides in the past 2-3 years but in absolute terms, there is still a long way to go.

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weve only just

BEGUN

Medicare has levied more than

$500MILLION in penalties against poor-performing

hospitals across almost every state.

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he increased uptake of cost-effectivemedicines is regarded as critical factor insuccessfully reaching the value paradigm. Assuch, the pricing and reimbursement of high-

value pharmaceuticals is, as ever, under close scrutiny.Furthermore, as the landscape evolves, pharmaceutical

companies in the worlds largest market are reviewing theiroperational models and exploring new methodologiesto demonstrate the value of their innovations and, in theprocess, helping payers and providers deliver against theirnew objectives.

Risk share has become a common theme, says Dr. NancyMcGee. Of course, there were risk-share environments inthe 1990s with managed care, but the landscape todayis quite different. Back in the 90s, we were talking aboutprovider risk share, cost shares, and patient risk shares. Butnow were talking about something new: manufacturer

risk share. There now exists an incredible opportunity formanufacturers to share risk in a way thats quite differentfrom anything thats been done previously and thecompanies that figure it out have the chance to be realwinners. Conversely, there will also be those who makepoor bets on how to assign that risk for example, abundled payment for a course of care where the drug isbundled in, but is not accounted for properly or paid in away that makes it possible to support. Getting the mathright will be crucial; its going to be fascinating seeing that

play out.

Risky

BUSINESS

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It comes down to really understanding and communicating value and data in a waythat people get it and make the right choice.

Lynn OConnor Vos, CEO, ghg

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So what does manufacturer risk look like and will it requirea dramatic overhaul of pharmas current operating model?Certainly, some companies are shifting focus away from thepromotion of clinical messaging and moving more towardsthe provision of services. But is this a developing trend,or are examples still the exception rather than the rule?

There is a growing belief, certainly within some integratedhealth systems, that it would be good if pharmaceuticalcompanies could start thinking about population healthinstead of product attributes, says Bill Meury. I understandthat concept but the gap between the notion and thepractice is still fairly wide. There will come a time whenpharma companies will wrap their products with servicesand help with managing population health rather than

just sel ling products. Some companies are already doingit, particularly in diabetes and MS. I t could certainly makea lot of sense but maybe not for every company in every

disease area. If pharma is to go down that road, however,then understanding and managing risk i s a big deal.

Its an embryonic approach thats certainly stimulatingrenewed optimism amongst payers but risk stratificationremains key. Its all about taking appropriate risk identifying the right patient where a specific drug is likely tohave the best outcome. Payers will have no problem payingfor a high-cost specialty drug if they can be sure theyre

targeting the patients where its going to have the bestclinical effect, says Dr. Nancy McGee.

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*During the ACA open enrollment period, Oct. 1, 2013 to April 15, 2014.Source: Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period, DHHS,

Office of the Assis tant Secretary for Planning and Evaluation, May 2014. http://aspe.hhs.gov.

85%of the 8 million purchasing insurance through

the exchanges received tax incentives

*


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here is also an increased focus on prevention.We have an army of care coordinatorsembedded in all of our clinical teams and theyspend a lot of time focusing on prevention, says

Lindsay Farrell. The last thing we want is for a pre- diabetic

to become diabetic from a government perspective thatsso much more expensive. So we have wellness classes,nutritionists and rumba classes under our roof, as well aslots of nonmedical providers working closely with patientsto ensure pre-diabetics maintain the right levels.

The same approaches are being taken within employers.Companies are doing similar things in-house, says LaurelPickering. Theyre introducing classes, programs andincentives to support employee well-being. Preventionreally is where the cost savings are.

The focus at the population level, however, i s not new.Moreover, says J.D. Kleinke, its at the disease level wherethe biggest challenges lie. Back in the mid 90s, whenthe data infrastructure came into place, many pharmacompanies began to look at the population level. But the

challenges center around disease; the highest costs are inknown disease states. For example, Hepatitis C is a highcost disease but there is now an expensive drug that,according to the data, not only cures it, but also eliminatesa tremendous amount of additional care and cost for thesystem. So on the one hand, you have an approach thattargets the whole population trying to fix the ocean ofdiabetes, and on the other you have a methodology thatfocuses on a high cost disease state like Hepatitis C anddelivers value across the continuum. On the face of it, thedrug is expensive; but so are liver transplants and people

dying of liver failure in hospital. Is this the way forward? Isthere now an opportunity for a drug company to par tneraround this kind of approach?

Preventative

MEASUREST

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The jury, for the time being at least, is out on this, withmany questioning pharmas capability (or indeed desire)to move into healthcare delivery. Certainly, the conceptof delivering system-wide cost savings is underpinnedby complex economics that will require a great deal ofunderstanding and collaboration before drug companiesdo more than simply dip their toes in the water. Accordingto Bill Meury, When we look at the mathematics here, weretypically talking about three separate buckets; inpatient

costs, outpatient costs and, in this case, the drug costs.(Thats certainly oversimplifying things, but for the sakeof illustration, it helps underline the point). When youhave a high cost drug, its very difficult to bring all of thatinformation together to figure out whether the price tagmakes sense. At the moment, Hepatitis C is a very specific,one-off example but when you start to look at large,expensive chronic disease categories, partnering withproviders is much more complicated.

My sense is that providers can do it themselves. AlthoughIve heard a lot of people suggest that drug companiesshould do more than just sell their products, I am muchmore cautious. We made the same mistake in the 1990swith disease management. This is not what pharma isgood at. Do people look to pharmaceutical companiesfor innovative therapies or to partner with companies onhealth care delivery? The answer is still the former. Althoughthere does need to be a change in the way we think about

this, pharmaceutical companies are good at discoveringand developing new therapies and thats where our focusshould remain.

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We have an army of care coordinators embedded in all of our clinical teams andthey spend a lot of time focusing on prevention.

Lindsay Farrell, President and CEO, Open Door Family Medical Center


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Value-based

PURCHASINGlearly, payment models and service design go right tothe heart of the value construct. The ACA sets out a clear

directive to test new delivery and payment system modelsin Medicaid and Medicare, as well as promising greater

oversight of health insurance premiums and practices. But how canthe shared benefits of value-based purchasing for all stakeholders,from providers through to patients be realized? After decades ofphysicians, insurers and providers dominating the dialogue, perhapsits now the consumer who holds the key to change.

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The whole system benefits of value-based purchasing are, ifthey can be achieved, both clear and significant: providersbenefit from the reduction in avoidable re-admissions,employers reduce their disability costs and enjoy associatedproductivity gains; the economy is boosted by increasedtaxation and lower welfare costs; and, most importantly of

all, patients benefit from improved health. But its not quitethat simple, and, economically at least, the benefits areunlikely to be shared evenly across the care continuum.

The Hepatitis C example underlines the challenge, saysLynn oConnor Vos. Typically, a provider wont have apatient for their full lifetime so they may take the hit ofthe high drug cost, but they wont feel the benefit of theliver transplant that was prevented. So as we start to lookat the lifetime value of a customer and begin to bringcustomer service approaches to healthcare, the question is:

how can we bring greater value to the patient across thatlifetime? For example, with a diabetic patient, well be therewith the insulin for the long haul but, as consumers beginto pay more for their health insurance, the patient is goingto expect more than simply the drug. They are going to bedemanding more from their providers and from pharma.

The cal ls for new payment models and financing strategiesare, as such, reaching fever pitch. One proposal is thedevelopment of mortgage-like payment models. Theconcept is that, rather than have a provider write the checkfor a high cost drug that may not reduce hospital costsuntil 4 years later, the purchase is funded on a mortgage-

like basis, says J.D. Kleinke. In the process, in cases wherepharmaceutical companies have developed high cost drugsthat get people back to work quicker, the value is capturedby the employer.

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But how can the shared benefits of value-based purchasing for allstakeholders, from providers through to patients be realized? After decadesof physicians, insurers and providers dominating the dialogue, perhaps itsnow the consumer who holds the key to change?

Laurel Pickering, President and CEO, Northeast Business Group on Health


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The concept may indeed have legs. Remodelingpayments around milestones and outcomes could work,says Dr. Nancy McGee. Pharma companies are good atdiscovering molecules and getting people interested inthem, but theyre also interested in the outcome of that

drug. In simple terms, this is just math. If we could find amathematician who could figure out a model that works,whether thats a mortgage or a milestone payment tied toan outcome, the payer would feel that value regardless ofwhere the patient travels.

Its a strong theory, but its success is dependent uponovercoming a major plague on global healthcare: poorpatient adherence. The true value of highcost medicinescan only be realized if patients persist with their treatments;and to achieve this, greater patient engagement will be

required right across the healthcare spectrum.

Its a key question: where is the patient in all of this? We aredoing all of this to the patient but unless we get the patientengaged, and unless the patient truly understands whattheir role in the game i s, we are probably not going to makeit very far, says Lynn oConnor Vos. This all comes downto communication and technology and thats becomingalmost as important as the medicines themselves. If wedont leverage technology, we risk failure. Who is going toplace the bet on the patient? And can we reject the patient

if they are not going to adhere?

Patient engagement is, of course, a broad and challengingarea. It all depends on where the patient is on thecontinuum of change, says Lindsay Farrell. You have toassess and constantly work with patients, but it is possibleto get engagement and have success. One of the things

that we did initially with our ACO patients was to look atsome of our most challenging cases and examine their casehistories and we recognized that the folks that fared theworst were the ones that didnt have a support system. Theywere living alone, they were obese, and every time they hita hospital there was a downward spiral. So we need to givethe patients a support system. How do we do it? It is reallynot that hard, but we dont have models for that in ourmedical delivery system presently. I expect that we wil l seea movement toward new models of supporting patients sothat they can be engaged in the future.

In fact, improvements in patient engagement and patientadherence are also coerced by virtue of another factor:the financial driver. Patients now need to pay more fortheir benefits and their healthcare, says Laurel Pickering.On the employer side, many organizations are increasingthe cost sharing that employees must pay, not only fortheir premium, but also at the point of care. There arean increasing number of consumer-driven health plans,or plans with high deductibles where the patient isresponsible for the first few thousand dollars. The idea is

that this is supposed to make consumers more engagedand turn them into better shoppers. In some cases it sworking, but communication between employers andemployees is still the key to better engagement.

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The below illustration was created by graphic recording fi rm ImageThink. Graphic recorder Lucinda Levine i llustratedthe key themes explored during the health spoken here forum.

Realities of the

AFFORDABLE CARE ACT


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CONSUMERIZATIONOF HEALTHCAREAnd so could it be that the consumerization of healthcare,despite the legislature of the ACA, is the real catalystfor value-based healthcare? There are huge differencesbetween now and 1999 not least technology, digital andthe mass consumerization of health, says Lynn oConnor

Vos. We have consumers who are online, reaching Dr.Google. Theyre using mobile phones and tablets, andthese smart devices are becoming their remote controlfor help. We are increasingly going to see more educatedconsumers, and this can only make a difference inhealthcare helping consumers make informed choices. In1999, everything was done at the consumer, now peopleare actually par ticipating in these decisions.

The credibilit y and accuracy of much of the informationavailable online still remains an issue; recent data shows

that a staggering 90% of health-related information onWikipedia is inaccurate to some extent. There is, therefore,clearly a place for a professional health-navigation industryto assist consumer decision-making, and physicians andpatient-advocacy groups will undoubtedly have a majorpart to play. But, as mobile and social channels gatherglobal momentum, digital communications are not goingto go away, and healthcare stakeholders must do all thatthey can to optimize them.

From a value perspective, the consumerization ofhealthcare is likely to lead to comparison shoppingin insurance exchanges, and increased competitionand price transparency. Consumers are increasinglyappalled by the variability in price they are now seeingfor standard healthcare procedures. There is a real push

for transparency, says Lindsay Farrell. People are horrifiedat the inequities, and that our tax dollars are paying forsuch huge variation in price. Why, for example, should onehospital charge ten times the amount of another for exactlythe same procedure? Worse still, in some cases, the cheaperhospital is delivering better health outcomes? Consumerswill no longer tolerate it.

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We are increasingly going to see moreeducated consumers, and this can onlymake a difference in healthcare helping

consumers make informed choices.Lynn OConnor Vos, CEO, ghg


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The common mantra that the most expensive is besthas, unlike other consumer industries, never applied inhealthcare. But thanks to increased transparency and (now)mainstream technologies, consumers are making moreinformed decisions. The era of the Expedia for healthcareis on its way, says Lynn oConnor Vos. There are alreadyexamples of applications where patients needing specificprocedures can log-in and look at a number of hospitals.

They load in their insurance, and can learn each hospital sservices, what their deductibles will be and what kind ofconcierge and after-care service they will get. And thenthey can make an educated choice.

Such consumer tools are also having an impact on privatehealth insurers. Companies like Castlight Health aredeveloping services to help employers and employees

understand benefit structures and quality. And morerecently, Aetna, Human, and United have al l announcedplans to make their benefits transparent too. Its makinga big difference, says Dr. Nancy McGee. This is perhapsthe key difference between now and the 1990s: accessto information. Its a real positive of the ACA that we, asconsumers, are able to see more information so that we canmake smarter decisions.

So what does all this mean for the pharmaceutical industry?Does the rapid consumerization of healthcare mean thatconsumers may one day opt for the big expensive brandbecause they fundamentally believe theyll get the mostvalue from it? It may not be that simple.

My sense is that its never just about the consumer, says BillMeury. Unless you have got the medical community and thepayer establishment on board, then going to the consumeris going to be less productive. In the past couple of years,its become clear that the amount of data and evidencethat is required to convince all 3 major audiences about therelevance of a product is much higher than it used to be.

Theres a psychology now, particularly when youre enteringa category that is well served, that without real innovationon the surface, youve got an uphill battle on your hands.

Thats not to say you cant be successful, but its highly likelythat to win in the value-based era, you have to reset yourexpectations and think about things a little differently.

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90%of health-related information on Wikipedia is inaccurate to some extent.

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Source: http://www.dailymail.co.uk/health/article-2639910/

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In a multidisciplinar y environment, where all the key constituentsadopt their own definition of value, the battle to reach the utopiaof value-based healthcare will remain challenging. Technology,communication, and information will undoubtedly play a majorrole in empowering stakeholders, and the ACA will provide astrong guiding hand in coercing all the main players to embracechange. For sure, everyone in the system is going to have to beaccountable for the value they bring to the table for the benefitof patient care.

More than anything, the journey towards patient-centric healthcare isgoing to take time. The question is: how much? Time is of the essence.One thing is for certain, in the rapidly-developing information age, thehealthcare and pharmaceutical industries must seize the mantle, collaborateand drive towards change we can no longer afford to party like its 1999.

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echnology, communication and information will

undoubtedly play a major role in empowering stakeholders,and the ACA will provide a strong guiding hand incoercing all the main players to embrace change

Laurel Pickering, President and CEO, Northeast Business Group on Health


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ghg is uniquely positioned to leverage the new paradigm for both providers and deliverers of healthcare. As a truly integratedmatrix of all essential elements of healthcare, from brand strategy to value engineering, ghg ensures that the landscape isoptimally navigated.

We speak health... everywhere it matters.

For more information, contact Claire Gillis at [email protected], or visit ww w.ghgroup.com.

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Navigating the Value-Based Paradigm: A Health Spoken Here Series

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