THE OPPORTUNITY FOR USING PATIENT-CENTRIC, …
Transcript of THE OPPORTUNITY FOR USING PATIENT-CENTRIC, …
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1ISPOR 21st Annual International Meeting
Workshop -Session IV
THE OPPORTUNITY FOR USING PATIENT-CENTRIC, COMPARATIVE EFFECTIVENESS AND OUTCOMES RESEARCH DATA: EVOLVING
APPROACHES TO VALUE DEMONSTRATION AND PRICING IN THE GLOBAL HEALTH CARE MARKETPLACE
Sue Ellen J. Kline, PhD, MS Principal Health Economist, Nucleus X Market Access, a Nucleus Global Company, Hamilton, NJ USA
Emily C. Freeman, MSc, PhD Senior Research Scientist, Global Patient Outcomes and Real World Evidence, Patient Focused Outcomes Center of Expertise, Eli Lilly and Company, Indianapolis, IN USA
Paul Hunt, MBA, President, Pricing Solutions Ltd, Toronto, Ontario, MSA Canada
ISPOR 21st Annual International Meeting, Workshop -Session IV
Wednesday, 25th May 2016 1:45 – 2:45 pm, Georgetown Ballroom
Washington Hilton, Washington, DC USA
© Pricing Solutions Ltd. 2014 2ISPOR 21st Annual International Meeting
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Today’s Workshop
This interactive workshop focuses on the growing importance of patient engagement for health care value demonstration • Effectively incorporating patient-centered/reported
data into strategy planning is high on the Global and increasingly the US radar screen
• Assessing patient-centered, real-world outcomes and comparative effectiveness is a key focus for pricing and access strategies
During this Workshop you will be asked to: Contribute your opinions on patient-centricity Discuss qualitative and quantitative comparative effectiveness, outcomes and pricing analytic methods
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Today’s Agenda
Workshop Introduction (SE Kline)
Patient Care Perspective (E Freeman)
Value Demonstration and Pricing (P Hunt)
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The Patient-centric Evolution(1)
Early 1980’s generic and disease-specific health-related quality of life (HRQoL), quality of life (QoL)
Predominantly in clinical trials and clinical research
Often administered by a clinician
Other types of analyses also available
Treatment satisfaction, preference
Time-trade off, willingness to pay, contingent valuation and conjoint analytic methodologies
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The Patient-centric Evolution(2) –The US Affordable Care Act
Patient-reported, patient-centered outcomes research2010 US Affordable Care Act (ACA)established the Patient Centered Outcomes Research Institute (PCORI)PCORI is the largest single financial supporter of clinical comparative effectiveness research consistently incorporating patients and other stakeholders throughout the process
The ACA legislation seeks to improve: Patient satisfaction with treatment and the quality of health care; The overall health of the US population; and…?Affordability
The “Triple Aim” of US Health Care Reform
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PCORI Sponsored Research (1)
Recently Published Example: Ying Xian, Emily C. O'Brien, Gregg C. Fonarow et al., “Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the Patient-Driven Research Paradigm to Aid Decision Making in Stroke Care,” American Heart Journal. 170(1) (July 2015): 36-45.
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PCORI Sponsored Research (2)
Recently Published Example: Herman PM, Ingram M, Rimas H, Carvajal S, Cunningham CE. ”Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care,” Adm Policy Ment Health. 2015 Sep 26. [Epub ahead of print] PubMed PMID: 26410547.
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Impact for US Stakeholders (1)
Continually evolving roles, relationships and experiences for patients, health care providers, payers
Treatment satisfaction survey after office visit
Multi-specialty, multi-level provider relationships
Consolidation
“Do more with less” while delivering high-quality care driving better outcomes
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Radnor Family Practice - Patient Experience Survey
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Impact for US Stakeholders (2)
For health care providers, payers, manufacturersMoving from a volume based to a value based and patient-centric care system
Providers incentivized to practice “accountable care”
Payers focus on paying for better economic, clinical and humanistic outcomes
Manufacturers increasingly challenged to demonstrate value
Value demonstration needs to be…? Comparative versus viable alternative treatment strategies
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Today’s Agenda
Workshop Introduction (SE Kline)
Patient Care Perspective (E Freeman)
Value Demonstration and Pricing (P Hunt)
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Today’s Agenda
Workshop Introduction (SE Kline)
Patient Care Perspective (E Freeman)
Value Demonstration and Pricing (P Hunt)
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Price
Value
Value Demonstration for Optimal Market Access: Inseparable – Price and Value
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Value-Based Pricing
Pricing is based on the perceived value of your products/services relative to other available
treatment, therapeutic options
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Pricing is a Key Core Competency
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The patient journey can provide clues as to the economic, clinical and humanistic outcome benefits of your price/value proposition
Patient journey (Help me!)
Physician as gatekeeper
Hospital/outpatient buyers as part of
committee
MCO payer as data interpreter
Consider including patients as well as physicians, hospital and outpatient provider purchasers and MCO payers as part of your patient access strategies
As you finalize your strategies, evaluate your price/value conclusions with KOLs and with interviews amongst knowledgeable respondents
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Possible to test the strength of physicians’ gatekeeper role at different price points
12% 10%
38% 40%
1st Line 2nd Line 3rd Line Not Used
Physician Forecast DRUG X Use at TEST PRICE POINT
40%
22%28%
10%
1st Line 2nd Line 3rd Line Not Used
Physician Forecast DRUG X Use Without Considering Costs
Some physicians are more price sensitive than others Some physicians are very active and knowledgeable about healthcare prices (e.g. Dr. Peter Bach,
DrugAbacus)
Those who think a new therapy/device has high clinical value are likely to be less price sensitive
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Value in the global health care market place is about delivering observable, measureable clinical and patient-centric benefits
Customer Benefits
Customer(s)Use Case
1BLINDED – type of clinical outcome with
particular patient type, in treatment pathwayPayer X X X X
2 Payer X X X X X X
3 Payer X X X
4 Payer X X X
5 Payer X X
6 Hospital X
7 Payer,
Hospital
X X
8 Payer X X X X X
Value can be assessed in different areas of Healthcare
Drugs – e.g. home administrationDevices – e.g. monitoringInformation – e.g. enabling fee-for-value
BLINDED – type of clinical outcome with
particular patient type, in treatment pathway
BLINDED – type of clinical outcome with
particular patient type, in treatment pathway
BLINDED – type of clinical outcome with
particular patient type, in treatment pathway
BLINDED – type of clinical outcome with
particular patient type, in treatment pathway
BLINDED – type of clinical outcome with
particular patient type, in treatment pathway
BLINDED – type of clinical outcome with
particular patient type, in treatment pathway
BLINDED – type of clinical outcome with
particular patient type, in treatment pathway
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The financial value of specific healthcare information ‘use cases’ is created by:
1. Increasing customers’ revenues
2. Decreasing customers’ expenses
3. Reducing customers’ capital requirements
What financial value does a specific healthcare information ‘use case’ deliver?
How does this differ for payers vs. providers?
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Fee-for-Value and paying for beneficial patient outcomes
• New drugs tend to have limited outcomes data at launch
• Efficacy data is very often on a clinical proxy rather than an observable clinical end-point
– e.g. PCSK9s for cholesterol lowering vs. cardiovascular events
• Fee-for-value approaches can be possible with suitable, robust data infrastructure
Source: Wall Street Journal, May 11, 2016.
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The Good, The Bad and The Ugly
Not all methodologies should be treated equal in the global health care industry. In
pricing research especially, methodologies can be Good some of the time, others,
Bad at times, and some are Ugly all the time:
THE GOOD
Discrete Choice/Tradeoff Analysis
Multivariate Regression Analysis (US)
In-Market Tests Price Value Measurement Monadic Testing Defection Analysis
(Won/Lost Analysis) Financial Value
Measurement
THE UGLY
x Direct Questioning
x Brand Price Tradeoff
Analysis (BPTO)
THE BAD
Van Westendorp
(Price Sensitivity Meter)
Price Laddering
Full Profile Conjoint
Analysis (rating &
sorting)
Methods of Conducting Pricing Research Data Collection
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The Value Demonstration Fairness Effect
Health care purchasers are more sensitive to price when it is outside the range that they perceive
as “fair” or “reasonable”
All health care stakeholders must work together to ensure patient access
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The Value Demonstration and Pricing Excellence Journey
Evidence based value demonstration and pricing in the global health care market place is a process
These processes are universal across diverse industries
Increasingly, in addition to clinical trial data, key value demonstration variables include real-world, evidence based patient-centric comparative effectiveness data
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Thank you for your participation today!
”The future ain’t what it used to be“– Lawerence “Yogi” Berra (1925-2015)
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Backup Slides
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An Example: Humanistic Outcomes in Wound Care - Methods
An English language only literature search of papers published between 1960 – 2012 was conducted (presented in March 2002 and updated May 2016) using a Boolean search strategy as follows:
“Venous ulcer”, “pressure ulcer”, “wound care” and “quality of life”The literature was reviewed for manuscripts that included the assessment of patient-reported generic and disease-specific humanistic outcomes Papers that simply mentioned the term “quality of life” and/or did not discuss QoL results in relation to wound care outcomes were excluded
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An Example: Humanistic Outcomes in Wound Care - Results
0
200
400
600
800
1000
1200
1400
1960 - 1979 1980 - 1990 1991 - 2001 2002 - 2012
Number of Manuscripts Citing “Quality of Life”by Publication Year
Venous Ulcer Pressure Ulcer Wound Care
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An Example: Humanistic Outcomes in Wound Care - Conclusions
American Medical Directors Association presentation in 2002 updated May 2016:
Most Qol assessment in patients with chronic wounds has been reported during the last ten yearsLittle consensus for the definition of and the appropriate measurement methodologies/tools for patient-reported outcomes for chronic wounds historically existedMeasurement of Qol in these patients provides another method to evaluate treatment success in addition to wound closure particularly in patients with difficult to and/or unwilling to heal woundsMore patient-reported, humanistic research is needed about disease-specific impact of chronic wounds to appropriately assess treatment options and optimize the clinical delivery of wound care solutions