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  • Bundled Payment Update eNewsletter
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RECENTLY FEATURED STORY
From June 19, 2017
Pay for Performance Update eNewsletter #99

Health Plans Are Actively Exploring Outcomes-Based Contracts
A new survey from Avalere finds that a majority of health plans have favorable attitudes toward outcomes-based contracts (OBCs) and many are actively pursuing them. Outcomes-based contracts are agreements between health plans and manufacturers that tie product reimbursement to patient outcomes. While the health plans surveyed recognize the operational challenges associated with outcomes-based contracts, they have broadly positive opinions about the value of deploying these contracts within their organizations. In a 2017 survey of health plans conducted by Avalere, 70 percent of health plans report they have favorable attitudes toward OBCs. One-quarter of the health plans surveyed say they have at least one OBC in place (see Figure 1). Another 30 percent report they are negotiating for one or more OBCs now. Among payers with OBCs in place, most indicate they plan to pursue more.

"Health plans, providers, and patients demand innovative, data-based methods to improve outcomes and manage cost," said Dan Mendelson, president at Avalere. "Outcomes-based contracts offer the opportunity to deploy data, analytics, and interventions to deliver on these goals for pharmaceuticals -- particularly to better integrate therapy into medical management."

As the shift to value-based care continues, according to experts at Avalere, the reach of innovative arrangements like OBCs is becoming broader. Today, most OBCs in place by the survey respondents address four common therapeutic areas -- endocrine, infectious disease, cardiovascular, and respiratory conditions -- but payers indicate they are interested in expanding OBCs within these areas and to new therapeutic areas, like immune/inflammatory diseases (see Figure 2).

"While some plans have experienced administrative and operational challenges in implementing outcomes-based contracts, most are figuring out ways to benefit from these types of contracts in multiple therapeutic areas," said Kathy Hughes, vice president at Avalere. "Solutions in data connectivity, contract monitoring, and direct clinician intervention streamline the administrative burden and enable transparency for all parties." (Avalere Press Release, May 30, 3017)


RECENTLY FEATURED VIDEO
From June 13, 2017
MACRA MIPs/APM Update eNewsletter #15


Health Policy Implications of the New Administration and Congress

Douglas Badger, Senior Fellow, Galen Institute

Chris Jennings, President and Founder, Jennings Policy Strategies, Inc.

Thomas P. Miller, Resident Fellow, American Enterprise Institute

Kavita Patel, Nonresident Senior Fellow, Brooking Institution

David Nash, Dean, Jefferson College of Population, Thomas Jefferson University


RECENTLY FEATURED RESOURCE
From June 19, 2017
Pay for Performance Update eNewsletter #99

2017 Review of Physician and Advanced Practitioner Recruiting Incentives


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