VBID Summit: Defining and Paying for Value in Healthcare

Various stakeholders in the healthcare industry are trying to determine value in healthcare, and speakers representing the pharmaceutical industry, research, and the patient perspective discussed the topic during the VBID Summit, hosted by the University of Michigan Center for Value-Based Insurance Design (VBID).

In the last 16 months there has been a proliferation of value frameworks, noted moderator Clifford Goodman, PhD, of The Lewin Group, who wondered what made assessing value such a big deal suddenly.

The increased focus on value in healthcare is partly due to the introduction of some very high cancer drug prices, said Richard J. Wilke, PhD, chief scientific officer of ISPOR, who added that there are 3 frameworks that are specific to cancer: from the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and Memorial Sloan Kettering Cancer Center. While there has always been a part of the healthcare industry that has been aware of cost and the issue of value, recent high-cost drugs have brought the spotlight more firmly onto the area.

“I think it’s just healthcare in general … has just become a real topic of conversation and this has been a part of that, with people seeking to explore what really defines value, what justifies what price,” Wilke said.

While the concept of frameworks could be beneficial, Eleanor Perfetto, PhD, senior vice president of strategic initiatives for the National Health Council (NHC), related that the organizations she represents, which are involved in patient engagement, were getting blindsided with new frameworks. Her membership hadn’t been asked to be involved in the development of data and only had a few weeks to respond to the framework.

NHC created a rubric for organizations looking to create value frameworks to ensure the patient is being considered and a checklist for members to prepare to engage with the frameworks. In the past, groups felt like the frameworks relevant to their disease state had implications for patient access and weren’t always based on accurate information.

“If this is going to happen, we have the opportunity to make the reports more correct and more representative of what patients are looking for and what patients value,” Perfetto said.

According to Jason Spangler, MD, MPH, FACPM, executive director at Amgen, the value equation is made up for 2 parts: budget impact and benefit. He presented 3 key points on value:

1. Value is not the same as budget impact. Payers tend to look short term, so budget impact is important, but in the long term, benefit becomes a more important factor in defining value.
2. There are multiple perspectives on value and there should be multiple stakeholders involved in the conversation.
3. The patient’s perspective had been lost for a while, but it’s starting to come back.

Perfetto added that the patient perspective of value takes on a different definition in healthcare. In a survey of patients, NHC asked “what is value to you?” but didn’t associate the question with healthcare. The responses mentioned getting the most for their dollar. The economic component is strong. However, when the question specified healthcare, the answer changed.

“The economic component is there, but not as much,” she said. “What they talk about more is quality of care, knowing that they’re receiving good care and good quality care, and knowing that they’re getting what they need and what their doctor thinks they need.”

Wilke added that it’s important to remember 2 things: some patients are more financially capable to pay for their care and patients may value treatment differently than health economists might. As a result, the healthcare industry is trying to understand the average value of treatment and then provide incentives, such as a reduction in co-pay, while remaining sensitive to individual patients’ valuation of treatment and ability to pay.

Goodman closed out the session by asking the panelists to consider what needs to be done so that in 5 years, the United States healthcare industry has made great strides in realizing value from both a population standpoint and the standpoint of individual patients.

Both Perfetto and Spangler agreed that in order to get to that point, the industry needs to have truly engaged patients and brought all of the stakeholders to the table. Spangler reiterated that the industry needs to have started looking at value in the long term and not just considering the cost, but also the benefits gained over a longer period of time.

Wilke advocated for implementing more pilots to try different things out. The industry should try some different approaches in practice and evaluate them.

“We don’t know what’s best for everybody—you’re probably going to make a mistake,” he said. “Let’s try some things. Markets don’t work really very well, we know, here, so we can’t rely on markets. But we have to at least try some things and evaluate how they work.”