Portraying Value Stories - Vanderbilt Health-Systems ... · Bhavesh Shah, R.Ph, BCOP. Director of...
Transcript of 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
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Disclosures
• Dr. Jolly has nothing to disclose• Dr. Shah has nothing to disclose
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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.
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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
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Stakeholder Conversations
• Payer• Industry• Pharmacy Community• C-Suite• Providers/Patients
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Payer
• Goals:• Control overall cost of healthcare
• Health-System SP Value• Accountability for admissions, ER visits, etc.• Ability to treat the patient holistically
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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
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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
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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
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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
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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
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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?]
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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
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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
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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
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<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
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f dea
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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
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Payer Implications
- Financial - Cost of non-adherence
- Clinical- Morbidity and mortality
- BMC HCV treatment center of excellence - BMC/Major payer collaboration
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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
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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
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Self-Assessment Questions
2. Which are stakeholders to whom outcomes research can be important?
a. Patientsb. Manufacturersc. Payers/PBMsd. Pharmaciese. All of the above
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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
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Thank you