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How VBC can work for manufacturers

Value-based contracts can present challenges that must be overcome to bring gene therapies to market.

Mari-Pat Kalla | March 2022

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As a continuation of my discussion about enabling value-based contracting (VBC) arrangements between life sciences manufacturers and the payer community, I dove into greater detail on the life sciences perspective with Erin Hulbert, the director of the Optum® Life Sciences value-based services team. 

Erin, can you go into detail about how the value-based services team interacts with the outcomes-based contracting enablement platform to support life science manufacturers?

The outcomes-based contracting enablement platform provides access to claims and enrollment information for patients who receive gene therapies as they move from payer to payer. First, it solves the portability problem. If we can evaluate claims for patients as they change health plans, we can measure outcomes over three, five or seven years. Second, the outcomes-based contracting enablement platform provides our team with the ability to support VBCs for the same therapy across multiple payers.

  • This brings consistency. For one therapy, that means the data that is available is the same from one payer to the next. And the outcomes are measured using the same methodology across different contracts.
  • It also allows scalability. Once set up, we can add more payers.
  • Consistency and scalability also mean that every value-based contract doesn’t need to reinvent the wheel. Sometimes what can sound simple is much more difficult to implement. While this platform may sound complex (and the backend supporting it certainly is), it really makes things easier to meaningfully measure real-world outcomes.

Finally, we can bring to bear the other capabilities that Optum has to offer.  We regularly procure and abstract patient charts and collect data directly from patients or caregivers. This means we can use patient-reported outcomes or other survey mechanisms as VBC evidence.  

We can link with other data, such as wearables or other monitoring devices. All of these could be used as outcomes for value-based contracts or as a source of deeper insights. This model allows for that.

From your perspective, what is the advantage of the outcomes-based contracting enablement platform for manufacturers over other types of approaches?

It’s all about consistency and scalability. With this platform, manufacturers can integrate the results of multiple VBCs to truly understand how their therapy is performing in the real world. They don’t have to try to make sense of outcomes that are measured in different ways across different systems.

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We’ve also repeatedly heard about the importance of trust on all sides of the agreement. Optum is a trusted partner to all of the key stakeholders, serving as a third-party administrator, and providing payment integrity as well as fraud and abuse services for a variety of payers. 

And Optum has a long history of conducting real-world analytics for manufacturers through our Optum Life Sciences business.

Our approach works for any eligible patient. It seeks to integrate outcomes tracking into existing processes and data streams, as opposed to adding new processes that may add further complexity for over-burdened providers, and inadvertently act as hurdles to patient access to therapy.

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There are a few final things to keep in mind. Some payers are not willing to have a VBC that relies on patient-reported data because of the voluntary nature of participation over time.

And both payers and manufacturers can be resistant to taking financial risks on patient-reported responses. They may want a provider’s documentation, such as claims or physician notes. This model solves for both of those concerns. 

I think it all comes down to one question: how do we do this well? The outcomes-based contracting enablement platform allows us to meaningfully measure outcomes over the time frame that is relevant to each of these therapies.

Optum is committed to our mission, and we have all the core capabilities required to do this well. That includes deep experience using real-world data for health economics and outcomes research expertise, robust data assets and the scale of Optum.

This puts us in a unique position to support value-based contracts.

You’ve emphasized the importance of starting early. How would a life sciences manufacturer engage with you to get started on developing a value-based program?

Our team is willing to engage with a life sciences partner wherever they are in their journey toward developing a meaningful outcomes-based program.

Often, the first step is engaging in a research study that leverages our de-identified real-world data assets. These include our claims data, structured electronic health record (EHR) data and unstructured EHR notes. We leverage these to characterize what is measurable and what could be used to support a potential value-based contract.

It is important to understand and build trust in the data that’s available today, and to understand what might need to change in the future. This helps build the foundation of insight necessary to engage payers and other stakeholders on the value of your therapy.

Another way we partner in value-based program concept development is through educational and consulting workshops. This helps manufacturers understand the processes and perspectives that health plans and other stakeholders bring to VBC conversations.

All this is part of building a well-thought-out VBC implementation strategy to support contracting, including which specific outcomes will be measured and a protocol for how they will be measured.  

It’s important for manufacturers to have this in place at approval to help with early access for their therapy. It also ensures the VBC helps generate compelling real-world evidence that can help prove the cost and quality of the therapy over time. 

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Finally, we can put all the upfront work in motion and support value-based program execution. Leveraging the outcomes-based contracting enablement platform and the scale of Optum allows us to measure meaningful outcomes for manufacturers in a consistent and objective way. 

How do we bring this home? How do we, collectively, payers, life sciences manufacturers and Optum, do this well?

We’d love to talk to others, just to share ideas, or to find ways to partner with manufacturers and payers in this space. The promise that gene and cell therapies hold for patients is real, and we are excited to work together to ensure that patients have affordable access to these transformative therapies.

Optum is committed to providing solutions that get the right treatments to the right patients at the right time — to meaningfully and measurably improve clinical outcomes and quality of life for patients.

Together, we can reshape health care for the good of all as we continue to innovate and connect disparate parts of the health system.

Thank you, Erin, for the discussion today.

Are you a life sciences manufacturer working on developing, implementing and executing outcomes-based programs? 

The Optum value-based services team can leverage the outcomes-based contracting enablement platform to help you get to a standardized infrastructure, data process, and measurement and reporting services that enable outcomes-based contracts with a broad set of payers.

Learn more about outcomes-based contract enablement.

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Mari-Pat Kalla

Vice President, Strategy and Product Innovation, Optum

Mari-Pat Kalla, vice president of Strategy and Product Innovation for Optum Life Sciences, has been leading product innovation in the clinical development, scientific consulting and outcomes-based contract enablement space for the past five years. 

Prior to joining Optum, Mari-Pat spent 15 years in new product marketing, market development and portfolio management roles in the medical technology and bio technology industries. She has a bachelor’s degree in chemical engineering from the University of Minnesota and an MBA from the UCLA Anderson School at Management.

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Erin Hulbert

Director, Value-Based Services, Optum Life Sciences

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