Oncology, CVD, Infectious Disease Most Common Areas for Outcomes-Based Contracts, Avalere Finds

Familiarity with outcomes-based contracts is already high among health plans, and a large majority of them are considering expanding their involvement in them, according to a new survey from Avalere Health. The survey involved 50 health plan representatives from 49 different organizations that represent at least 183 million of the covered lives in the United States.

The survey found that one-fourth of plans already have an outcomes-based contract in place, and 85% of those plans are considering more contracts. One-third of plans that do not currently have an outcomes-based contract are considering one.

The most common areas for outcomes-based contracts are cardiovascular disease, infectious disease, and oncology. While cardiovascular and infectious diseases both have clearly defined outcomes, the metrics for oncology outcomes-based contracts are not as well established, according to Avalere.

The survey found that 64% of plans with outcomes-based contracts have a contract in a cardiovascular disease, such as hypercholesterolemia, heart failure, or atrial fibrillation; 42% have a contract in an infectious disease, such as hepatitis C; and 32% have a contract in oncology. Other therapeutic areas where plans have outcomes-based contracts are orthopedics, endocrinology, immune/inflammatory diseases, rare/orphan diseases, and respiratory diseases.

“Our survey results indicate payers are examining outcomes-based contracts in oncology, for which measures for success have been elusive,” Dana Macher, senior vice president at Avalere, said in a statement. “Recent drug launches and a strong oncology pipeline may be compelling plans to explore outcomes-based contracts as a way to help balance access and cost.”

In 2018, nearly all (98%) of respondents were at least somewhat familiar with outcomes-based contracts. Compared with 2017, the proportion who said they were very familiar increased (54% in 2018 vs 48% in 2017).

According to the survey results, health plans are having more conversations about outcomes-based contracts within the organization, with 36% reporting they discuss these contracts a great deal (up from 25%) and 49% saying they have some conversations within the organization (up from 42%).

“Outcomes-based contracts are becoming more of a mainstream topic within health plans,” said Matt Brow, president of Avalere. “While most remain in an exploratory stage, plans that have accrued some experience with outcomes-based contracts are interested in pursuing more.”