THE SITUATION E N V I R O N M E NTA L C H A N G E : H E A LT H C A R E D EL I V ERY ’ S M E TA M O R P H O S I S
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ast month, in the January issue of Pf Magazine, I discussed evolving accountable care systems and organisations. The key features in these evolving systems are outcome focus, long-term approach, integration of services and delivery at scale. One of the questions I posed, following the piece, was: can both pharma and healthcare providers enter into meaningful yet pragmatic, outcome-based commercial relationships or will it be business as usual? So, let’s deconstruct what outcome-based deals might look like. On first examination, it could be conceded that they are not altogether new; stakeholders have explored the concepts of ‘value based pricing’ and ‘outcome guarantees’ for years. The former is a general term which is used to describe pricing based on specific cost-effectiveness thresholds, rather than arbitrary pricing. The latter provides money back if the product doesn’t perform to an agreed standard. These can operate as separate concepts or could go hand in hand; value-based pricing with an outcome guarantee could be used when benefits are uncertain, due to immature evidence perhaps, and the resulting risks for the payer are high. The NHS has dabbled with this approach through early ‘patient access schemes’, which facilitated cost-effective pricing when
2 4 | PH A R M A FI EL D.CO.U K
Firm handshake Can pharma drive innovative relationships in the evolving NHS? WORDS BY
Dr Duncan Jenkins
the NICE TA submissions looked shaky. Initial schemes managed risks associated with uncertainty around parameters, such as initial response rates, duration of treatment or size and number of doses. Indeed, the NHS struggled with completing the onerous paperwork, while companies confused even themselves with the complex deals they created. Patient access schemes have now reverted to simple discounts or rebates as the administrative burden was simply too high. These old schemes are even less likely to work in the new world where there is less interest in whether ‘drug A achieves outcome B in patient C’, and more focus is given to outcomes achieved across
patient populations defined by a specific condition. Successful achievement will be down to the combined efforts of care systems, professionals, patients and their families, as well as broader population health promotion measures. The critical factors that will be addressed include treatment pathways and algorithms, decision support measures, adherence to treatment, self-care and a whole raft of other small, but helpful stuff. The outcomes focus will be driven by quality improvement methods where systems are tweaked to achieve proxy outcomes in the short-term, with the expectation that these will lead to improvements in health status downstream.