Digital Platforms Vitalize Value-Based Care in Life Sciences
Biopharmaceutical companies are entering new territory by inking risk-sharing contracts with payers. Accordingly, they must move fast to digitize collaborative frameworks that measure and influence patient outcomes.
In the life sciences and healthcare industries, value-based care is the predominant enabling model that offers the potential to bring together life sciences companies, providers, payers and patients to improve both financial and health outcomes. At the same time, it requires robust platforms to measure, benchmark, report and optimize those outcomes. Success in this new environment requires all stakeholders to collaborate and develop frameworks that can be digitized into agile technology platforms and systems of intelligence to gather data and distill meaning.
The basic idea of value-based care is that reimbursements are based on the quality of the outcome of a healthcare procedure, episode of care, use of a device or therapy. Life sciences companies, from biopharma to medical device manufacturers, are rewarded for improving health outcomes and/or reducing the costs to achieve those outcomes — but paid less when their therapies are less efficacious than expected.
This model impacts numerous life sciences operations, from R&D through the commercial phase:
“Go/no-go” decisions must be made earlier in the development cycle.
Evidence must be gathered for mature therapies to prove their value.
New business development and contracting skills are required.
Deeper engagement with patients is necessary to ensure medical adherence.
Research shows the shift toward a value-based approach is being driven by pressure from commercial payers, varying by disease category (see Figure 1). In recent years, multiple risk-sharing agreements have been signed and are making an impact on the commercial strategies of life sciences companies. These risk-sharing arrangements can be a “win-win” for all stakeholders, but they require a dramatic change in business models, especially within life sciences companies. A data infrastructure and analytics must be in place to ensure that proposed deals are structured and negotiated profitably, to measure outcomes independently and to adjudicate payments fairly and transparently.
These deals will require significant investments in digital platforms and new skill sets — i.e., the ability to combine and analyze data from multiple sources to create actionable insights. According to our survey, 84% of life sciences executives cited analytical skills as most relevant and essential for the future; 74% cited strategic thinking and 68% decision-making.
Technology Platforms & Value-Based Care
We believe the technology platform is set to be the organizing principle for innovation within and between companies as co-creation increases. In life sciences, the software layers that compose the platform gather data from a specific pharmaceutical process, a clinician need or a patient requirement. The platform then becomes an open data exchange, where scientists, regulators, doctors, patients and other life sciences stakeholders can index, experiment and collaborate to improve drugs, treatments and outcomes.
One example from the life sciences industry is the Shared Investigator Platform (SIP), built for members of TransCelerate BioPharma, a nonprofit, cross-industry organization with a mission to collaborate across the R&D community to implement solutions that drive efficient, effective and high-quality delivery of new medicines. The SIP was designed as a cross-industry solution to reduce the administrative burden on investigator sites and ultimately enhance efficiency during clinical trial planning and execution.
Agile life sciences ventures will emerge, pivoting around data mastery, innovation and value. Verb Surgical Inc., for example, was founded in 2015 to develop a digital surgery platform built with technology from partners Verily and Ethicon. Its goal is to “democratize surgery” by making technology and information available to more patients globally, improving outcomes and reducing overall cost of care.
We have identified three areas where we believe technology platforms will drive success in value-based care for life science companies in the short term:
Incorporating real-world evidence into R&D investment decisions and studies:
As profit margins are squeezed across the life sciences industry, R&D investments and clinical study designs must take into consideration economic and competitive factors affecting therapeutic areas and the cost of care. Real-world evidence (RWE) must become part of the equation in go/no-go decisions as well as in developing study protocols that measure outcomes and value.
Designing and administering outcomes-based pricing contracts:
The Health Care Transformation Task Force is an industry consortium that assembles provider networks, payers, purchasers and patient groups with the “triple aim” of better health, better care and lower costs. With a commitment from its payer and provider members to put 75% of their respective businesses under value-based payment arrangements by January 2020, the task force is focused on value-based care that is permeating its negotiations with life sciences companies for new drug therapies.
Measuring and influencing patient outcomes:
With revenue and profits riding on patient outcomes, perhaps the best investment in technology are platforms that help patients get the best results possible and provide evidence of these results. Life sciences companies have developed a plethora of patient support programs that have been effective in tightening the relationship with patients and can contribute to the body of real-world evidence to demonstrate success to payers.
At the same time, the industry needs a deeper understanding of the patient journey and the patient’s willingness to interact with technology in order to design and deploy these solutions. New techniques in anthropology, digital ethnography and evidence-based research are being applied to develop the most appropriate strategies for meeting patients’ needs. In research conducted with partner ReD Associates, we found that patient desire for greater empathy, personalization and autonomy in their healing journeys is often at odds with a healthcare system that focuses on measurable outcomes.
With platforms underpinning value-based care strategies, life sciences companies can better adapt to changes the healthcare industry can hardly imagine. In the meantime, platforms will enable life sciences companies to gather and analyze data throughout their product lifecycles and patient journeys to succeed under value-based care reimbursement models.