portraying value stories - vanderbilt health-systems ... · bhavesh shah, r.ph, bcop. director of...
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Portraying Value Stories
March 7, 2019
Jacob A. Jolly, PharmD, CSP
Program Director, Specialty Pharmacy
Vanderbilt University Medical Center
Bhavesh Shah, R.Ph, BCOP
Director of Specialty and Hematology/Oncology Pharmacy
Boston Medical Center Health System
Disclosures
• Dr. Jolly has nothing to disclose• Dr. Shah has nothing to disclose
Learning Objectives• 1. Understand the perspectives and goals for a
variety of stakeholders in the specialty pharmacy industry
• 2. Evaluate the utility of outcomes research in interfacing with patients, provider, payers, and manufacturers
• 3. Explore forward-facing ideas for how outcomes research and collaboration can contribute to the continued growth and relevance of a specialty pharmacy program.
Move to value based care
• All stakeholders will become accountable for their own outcomes
• Payers – cost of care• Manufacturers – clinical outcome of drug
compared to trials• Pharmacies – successful patient journey
• Outcomes research is a vehicle through which we can begin to measure value
Stakeholder Conversations
• Payer• Industry• Pharmacy Community• C-Suite• Providers/Patients
Payer
• Goals:• Control overall cost of healthcare
• Health-System SP Value• Accountability for admissions, ER visits, etc.• Ability to treat the patient holistically
Industry• Goals:
• Ensure patients access their drug quickly, safely, and efficiently
• Demonstrate value of drug post-clinical trial
• Health-System SP Value• Access to clinical data can facilitate shorter approval
process• Ability to manage monitoring requirements
seamlessly due to integration• Outcomes research can show real world value of drug
Pharmacy Community
• Goals:• Measure value and outcomes• Ensure effective benchmarking
• Health System SP Value• Theoretically have the ability to follow and
measure outcomes across the entire patient journey
• Academic medical centers – research community
C-Suite
• Goals• Treat patients effectively, safely, and with
high levels of quality• Ensure financial success and sustained
growth for their institution• Health System SP Value
• Demonstrate quality of practice• Outcomes research can play a part in
strategic partnership formation
Providers
• Goals• Treat patients as they find clinically appropriate• Manage medications continuously between visits• Lower the administrative burden to clinic staff and
providers
• Health System SP Value• Ability to increase continuity of care with frequent touch
points and seamless communication to providers• Demonstrate efficiency and speed of access and turn-
around-time
Patients
• Goals• Receive the best available care• Seamless healthcare experience
• Health System SP Value• Ability to demonstrate operational (TAT,
approval rate) and clinical (outcome) endpoints
• Integration with the healthcare team allows for continuity of care
Case #1 Payer Value Story
• VSP patients had significantly higher completion rates on HCV treatments
• VSP patients showed comparable cure rates to clinical trials• Achieving cures for patients with chronic hepatitis C [insert blurb
about cures saving money to the system in the long run?]
Case #2: Manufacturer Value Story
• Cure rates• Demonstrates the real-world value of their drug
• Access rates• VSP had 100% of patients access HCV treatment• 98% insurance approval
Case #3: Patient Value Story
• Patients achieved cure at comparable rates to clinical trials• 53% of patients paid $0.00 out-of-pocket for their HCV treatment
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A Story on Portraying ValueBoston Medical Center
Examples of Partnerships Developed Through Clinical Outcomes
- Payer story:2 Major commercial payer contracts BCBSMA, Harvard pilgrim
2 Managed care medicaid plans
- Pharma story:Access to limited distribution drugs
Pfizer example
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Current and Future Value Based or Outcome Based Contracting
Oncology ̶ Larotrectinib (Viktrakvi) ̶ Annual cost $393,000 per patient ̶ No response within 60 days then manufacturer refunds all costs
CAR-T cell ̶ Annual cost $475,000 per treatment ̶ With CMS (no response at 30 days then full refund)
Bevacizumab ̶ Genentech/Priority health ̶ % of rebate tied to median PFS for each patient
Biosimilar̶ % of conversion tied to rebates (example 80% conversion = 10% rebate, 85% conversion 15% rebate, etc…)
Biologics (non-oncology) ̶ IL-23 response < PASI 90 at 12 weeks tied to % in rebate
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Case study – Hepatitis C
0
200
400
600
800
1000
1200
1400
1600
1800
<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Mortality among HCV Cases in Massachusetts1
Years to death from date of HCV diagnosis
Num
ber o
f dea
ths
1 Lijewski, et al, 2012. Timing of mortality among known HCV cases in Massachusetts, 1992-2009
76,122 HCV diagnoses were reported to the MDPH between 1992 and 2009. 8,499 of these reported HCV cases died and are represented in the figure. Data of 1/11/2011.
Median interval: 3 yearsMedian age: 53 Years
Payer Implications
- Financial - Cost of non-adherence
- Clinical- Morbidity and mortality
- BMC HCV treatment center of excellence - BMC/Major payer collaboration
Summary
• Knowing the perspectives and goals of stakeholders in the specialty pharmacy industry is important in developing meaningful outcomes research
• Outcomes projects can make an impact on many different stakeholder groups
• Outcomes projects and research can be a centerpiece in demonstrating value for key discussions across specialty pharmacy partners
Self-Assessment Questions
1. What is a goal that is commonly aligned between all stakeholder groups?
a. Controlling cost of healthcareb. Ensuring patients receive the benefit of their therapyc. Fostering the growth of a specialty pharmacy programd. All of the above
Self-Assessment Questions
2. Which are stakeholders to whom outcomes research can be important?
a. Patientsb. Manufacturersc. Payers/PBMsd. Pharmaciese. All of the above
Self-Assessment Questions
3. Outcomes projects and research may be instrumental as more focus in specialty pharmacy is on:
a. Value-based careb. Transparencyc. Fee-for-serviced. All of the above
Thank you