PNS155 VALUE-BASED CONTRACTING: DO PERSPECTIVES DIFFER BY PAYER TYPE?

Abstract

Value-based contracts (VBCs) continue to receive attention as a mechanism for the shift toward value in the U.S. healthcare system. Under this model, stakeholders align drug payment and value to real-world performance metrics. Prior published payer research has not addressed VBCs according to payer type. An online survey assessing experience with VBCs, barriers to implementation, and elements required in establishing successful VBCs was completed by payers. Respondents (N=47) represented health plans (HP; n=28), integrated delivery networks (IDN; n=10) and pharmacy benefit managers (PBM; n=9). At least one VBC was active or pending for greater than half of IDNs (60%) and PBMs (67%), while HPs (43%) had fewer active or pending VBCs. Clinical outcomes and compliance were the most common evaluation metrics for all payer types. The most common barriers to implementing VBCs were the ability to negotiate acceptable contract terms (HPs 71%; IDNs 40%; PBMs 78%), inability to obtain accurate/credible data to measure outcomes (HPs 57%; IDNs 70%; PBMs 78%), and implementing technology to collect data (HPs 54%; IDNs 50%; PBMs 78%). Simple and easily measurable outcomes, sufficient patient population, and reasonable timeframe for the contract were rated as the most important elements in establishing VBCs. IDNs may have more flexibility when considering each of these elements and place elevated importance on sharing risk (90%) compared to HPs (71%). Manufacturers’ support of case management and adherence/compliance initiatives was endorsed by most IDNs (70%) and PBMs (67%), but fewer HPs (36%). Compared to HPs (32%) and PBMs (22%), IDNs (60%) reported the most interest in utilizing a mediator to analyze the risk before initiating VBC discussions. Surveyed payers are interested in VBCs, but utilization varies by payer type. Results indicate payer type should be considered as one element of a payer-manufacturer VBC partnership, and emphasis placed on flexibility.