Experts Discuss Innovations in Care Delivery, Technology Driving Integration of Patient-Centric Value Frameworks

The shift to patient-centric value frameworks from traditional payment systems continues to be burdened by inadequate data collection, measurement, and evaluation of novel therapeutics, noted experts during a Wednesday session at the Academy of Managed Care Pharmacy (AMCP) Nexus 2022 meeting.

Technology and advances in models of care delivery were described as key innovations to overcome these challenges, with a collective effort between patients, providers, and other members involved in the treatment value chain also required.

Describing patient-centric value frameworks as models that go beyond traditional measures of health care cost, clinical effectiveness, and adverse events, Shelby Harrington, MS, RN, principal of Quality and Clinical Strategy at Avalere Health, highlighted the evolving perception of value across the health care landscape and its implications for each patient population.

“Value is not always distributed equally, and assessing value for entire populations must take into account how that value is distributed within the population, how access to therapies impacts the equitable distribution of health benefits, and therefore the overall value for a given therapy,” she said. “Value frameworks are methods by which evidence is used to assess the value of the health care product or service.”

Focusing on the holistic real-world impact of care choices beyond cost effectiveness, real-world evidence (RWE) and patient-reported data are also leveraged in these value frameworks to account for patient preferences and address issues within the health care environment or externally as well (eg, social determinants of health [SDOH], accessibility).

However, Harrington noted that patient-centric value frameworks are difficult to define and measure, as well as challenging to apply at the population level due to heterogeneity. In the United States, there is no official value-assessment process, in which several organizations, such as the Institute for Clinical and Economic Review (ICER) and the American Society for Clinical Oncology (ASCO), have developed traditional frameworks that are specific to their respective stakeholder needs.

“There are a few frameworks that can serve both population level decisions and individual level decisions, [but] most are oriented towards one or the other.”

Regarding patient-centric value frameworks, these tools serve as guidance for providers, payers, patients, and other health care decision-makers, but should not be the sole factor considered and are intended to be used in conjunction with other tools and resources.

“With payers and pharmacy benefit managers, you're looking at overall coverage decisions, utilization management practices, negotiating rates, and managing formularies. For providers, it's a systematic way to compare care options and care pathways for their patient populations,” she said. “Similarly for individual patients, it can support shared decision-making.”

RWE, specifically health economics and outcomes research, plays a significant part of the resulting guidance provided through value frameworks, and can bring more nuanced perspectives even within the traditional models as well, said Harrington.

Sarah Alwardt, MEng, PhD, senior vice president of Advisory Services at Avalere Health, added that her decision-making process when integrating claims data is conducted similar to that of a pyramid model, in which safety and efficacy are at the bottom, followed by pricing discussions, and at the very top is patient centricity.

As clinical trials typically involve a minority demographic of each given patient population, and are burdened by diversity and eligibility issues, utilizing RWE can enhance the patient centric approach when consulting with patients on what therapy meets the goals and preferences of their care journey.

“It's in the data that we're looking at every single day. The interesting thing in looking at overall survival is that [while] survival is important to patients, they're not really there to see the upside of that end point. Was there something else that could have helped them understand the value of therapy along the line rather than kind of waiting towards the end?” said Alwardt.

Patient preferences and consideration of SDOH and other external factors are key to achieving value-based care delivery, but the lack of data on these variables or even a mechanism to define their impact remains a major limitation to the integration of these frameworks.

Advancements in technology may help to address some of the data concerns, Harrington said, with the use of virtual trials reducing the burden of patient participation, as well as remote patient data monitoring in decentralized trials where there's less of a requirement for patients to require transportation.

“We have to be much more methodical and committed to collecting data from patients about their experience of illness and their experience of treatment, and apply more resources to understand how those treatments work under real world conditions and the impacts they have on patients day-to-day lives,” noted Harrington.

With over 40% of US health care payments found to be tied to alternative payment models in 2021, the shift toward value-based frameworks has already shown progress. Federal legislation and regulatory action, particularly the 21st Century Cures Act and CMS’s Coverage with Evidence Development, are also promoting value-based innovation for traditionally underrepresented patient populations.

“I think traditional frameworks have been incredibly valuable in starting the conversation. We have to start somewhere and we need to make wise use of our resources. Health care is eating a very significant portion of US spending and with the advent of more technology and more expensive therapies, we need to be good stewards of that,” said Harrington. “The fact that we do have frameworks for measurement and we're moving in a direction where we’re having that conversation is really important, [but] there’s still much to improve.”

“We believe that having patient centricity is important and that is a direction that we need to move towards. But it also comes with an obligation that's going to be on all of us as well, and that is that no one group is going to sit down and have this figured out by itself. It's going to take increasing trust in RWE, quality data, and amazing methodologists coming together to have this work,” concluded Alwardt.