THE OPPORTUNITY FOR USING PATIENT-CENTRIC, …

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1ISPOR 21st Annual International Meeting

Workshop -Session IV

THE OPPORTUNITY FOR USING PATIENT-CENTRIC, COMPARATIVE EFFECTIVENESS AND OUTCOMES RESEARCH DATA: EVOLVING

APPROACHES TO VALUE DEMONSTRATION AND PRICING IN THE GLOBAL HEALTH CARE MARKETPLACE

Sue Ellen J. Kline, PhD, MS Principal Health Economist, Nucleus X Market Access, a Nucleus Global Company, Hamilton, NJ USA

Emily C. Freeman, MSc, PhD Senior Research Scientist, Global Patient Outcomes and Real World Evidence, Patient Focused Outcomes Center of Expertise, Eli Lilly and Company, Indianapolis, IN USA

Paul Hunt, MBA, President, Pricing Solutions Ltd, Toronto, Ontario, MSA Canada

ISPOR 21st Annual International Meeting, Workshop -Session IV

Wednesday, 25th May 2016 1:45 – 2:45 pm, Georgetown Ballroom

Washington Hilton, Washington, DC USA

© Pricing Solutions Ltd. 2014 2ISPOR 21st Annual International Meeting


ISPOR 21st Annual International Meeting Workshop -Session IV2

Today’s Workshop

This interactive workshop focuses on the growing importance of patient engagement for health care value demonstration • Effectively incorporating patient-centered/reported

data into strategy planning is high on the Global and increasingly the US radar screen

• Assessing patient-centered, real-world outcomes and comparative effectiveness is a key focus for pricing and access strategies

During this Workshop you will be asked to: Contribute your opinions on patient-centricity Discuss qualitative and quantitative comparative effectiveness, outcomes and pricing analytic methods

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Today’s Agenda

Workshop Introduction (SE Kline)

Patient Care Perspective (E Freeman)

Value Demonstration and Pricing (P Hunt)

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The Patient-centric Evolution(1)

Early 1980’s generic and disease-specific health-related quality of life (HRQoL), quality of life (QoL)

Predominantly in clinical trials and clinical research

Often administered by a clinician

Other types of analyses also available

Treatment satisfaction, preference

Time-trade off, willingness to pay, contingent valuation and conjoint analytic methodologies

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The Patient-centric Evolution(2) –The US Affordable Care Act

Patient-reported, patient-centered outcomes research2010 US Affordable Care Act (ACA)established the Patient Centered Outcomes Research Institute (PCORI)PCORI is the largest single financial supporter of clinical comparative effectiveness research consistently incorporating patients and other stakeholders throughout the process

The ACA legislation seeks to improve: Patient satisfaction with treatment and the quality of health care; The overall health of the US population; and…?Affordability

The “Triple Aim” of US Health Care Reform




PCORI Sponsored Research (1)

Recently Published Example: Ying Xian, Emily C. O'Brien, Gregg C. Fonarow et al., “Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the Patient-Driven Research Paradigm to Aid Decision Making in Stroke Care,” American Heart Journal. 170(1) (July 2015): 36-45.

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PCORI Sponsored Research (2)

Recently Published Example: Herman PM, Ingram M, Rimas H, Carvajal S, Cunningham CE. ”Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care,” Adm Policy Ment Health. 2015 Sep 26. [Epub ahead of print] PubMed PMID: 26410547.




Impact for US Stakeholders (1)

Continually evolving roles, relationships and experiences for patients, health care providers, payers

Treatment satisfaction survey after office visit

Multi-specialty, multi-level provider relationships

Consolidation

“Do more with less” while delivering high-quality care driving better outcomes

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Radnor Family Practice - Patient Experience Survey




Impact for US Stakeholders (2)

For health care providers, payers, manufacturersMoving from a volume based to a value based and patient-centric care system

Providers incentivized to practice “accountable care”

Payers focus on paying for better economic, clinical and humanistic outcomes

Manufacturers increasingly challenged to demonstrate value

Value demonstration needs to be…? Comparative versus viable alternative treatment strategies

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Today’s Agenda







Today’s Agenda




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Price

Value

Value Demonstration for Optimal Market Access: Inseparable – Price and Value




Value-Based Pricing

Pricing is based on the perceived value of your products/services relative to other available

treatment, therapeutic options

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Pricing is a Key Core Competency




The patient journey can provide clues as to the economic, clinical and humanistic outcome benefits of your price/value proposition

Patient journey (Help me!)

Physician as gatekeeper

Hospital/outpatient buyers as part of

committee

MCO payer as data interpreter

Consider including patients as well as physicians, hospital and outpatient provider purchasers and MCO payers as part of your patient access strategies

As you finalize your strategies, evaluate your price/value conclusions with KOLs and with interviews amongst knowledgeable respondents

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Possible to test the strength of physicians’ gatekeeper role at different price points

12% 10%

38% 40%

1st Line 2nd Line 3rd Line Not Used

Physician Forecast DRUG X Use at TEST PRICE POINT

40%

22%28%

10%

1st Line 2nd Line 3rd Line Not Used

Physician Forecast DRUG X Use Without Considering Costs

Some physicians are more price sensitive than others Some physicians are very active and knowledgeable about healthcare prices (e.g. Dr. Peter Bach,

DrugAbacus)

Those who think a new therapy/device has high clinical value are likely to be less price sensitive




Value in the global health care market place is about delivering observable, measureable clinical and patient-centric benefits

Customer Benefits

Customer(s)Use Case

1BLINDED – type of clinical outcome with

particular patient type, in treatment pathwayPayer X X X X

2 Payer X X X X X X

3 Payer X X X

4 Payer X X X

5 Payer X X

6 Hospital X

7 Payer,

Hospital

X X

8 Payer X X X X X

Value can be assessed in different areas of Healthcare

Drugs – e.g. home administrationDevices – e.g. monitoringInformation – e.g. enabling fee-for-value

BLINDED – type of clinical outcome with

particular patient type, in treatment pathway













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The financial value of specific healthcare information ‘use cases’ is created by:

1. Increasing customers’ revenues

2. Decreasing customers’ expenses

3. Reducing customers’ capital requirements

What financial value does a specific healthcare information ‘use case’ deliver?

How does this differ for payers vs. providers?




Fee-for-Value and paying for beneficial patient outcomes

• New drugs tend to have limited outcomes data at launch

• Efficacy data is very often on a clinical proxy rather than an observable clinical end-point

– e.g. PCSK9s for cholesterol lowering vs. cardiovascular events

• Fee-for-value approaches can be possible with suitable, robust data infrastructure

Source: Wall Street Journal, May 11, 2016.

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The Good, The Bad and The Ugly

Not all methodologies should be treated equal in the global health care industry. In

pricing research especially, methodologies can be Good some of the time, others,

Bad at times, and some are Ugly all the time:

THE GOOD

Discrete Choice/Tradeoff Analysis

Multivariate Regression Analysis (US)

In-Market Tests Price Value Measurement Monadic Testing Defection Analysis

(Won/Lost Analysis) Financial Value

Measurement

THE UGLY

x Direct Questioning

x Brand Price Tradeoff

Analysis (BPTO)

THE BAD

Van Westendorp

(Price Sensitivity Meter)

Price Laddering

Full Profile Conjoint

Analysis (rating &

sorting)

Methods of Conducting Pricing Research Data Collection




The Value Demonstration Fairness Effect

Health care purchasers are more sensitive to price when it is outside the range that they perceive

as “fair” or “reasonable”

All health care stakeholders must work together to ensure patient access

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The Value Demonstration and Pricing Excellence Journey

Evidence based value demonstration and pricing in the global health care market place is a process

These processes are universal across diverse industries

Increasingly, in addition to clinical trial data, key value demonstration variables include real-world, evidence based patient-centric comparative effectiveness data




Thank you for your participation today!

”The future ain’t what it used to be“– Lawerence “Yogi” Berra (1925-2015)

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Backup Slides




An Example: Humanistic Outcomes in Wound Care - Methods

An English language only literature search of papers published between 1960 – 2012 was conducted (presented in March 2002 and updated May 2016) using a Boolean search strategy as follows:

“Venous ulcer”, “pressure ulcer”, “wound care” and “quality of life”The literature was reviewed for manuscripts that included the assessment of patient-reported generic and disease-specific humanistic outcomes Papers that simply mentioned the term “quality of life” and/or did not discuss QoL results in relation to wound care outcomes were excluded

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An Example: Humanistic Outcomes in Wound Care - Results

0

200

400

600

800

1000

1200

1400

1960 - 1979 1980 - 1990 1991 - 2001 2002 - 2012

Number of Manuscripts Citing “Quality of Life”by Publication Year

Venous Ulcer Pressure Ulcer Wound Care




An Example: Humanistic Outcomes in Wound Care - Conclusions

American Medical Directors Association presentation in 2002 updated May 2016:

Most Qol assessment in patients with chronic wounds has been reported during the last ten yearsLittle consensus for the definition of and the appropriate measurement methodologies/tools for patient-reported outcomes for chronic wounds historically existedMeasurement of Qol in these patients provides another method to evaluate treatment success in addition to wound closure particularly in patients with difficult to and/or unwilling to heal woundsMore patient-reported, humanistic research is needed about disease-specific impact of chronic wounds to appropriately assess treatment options and optimize the clinical delivery of wound care solutions

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