Optum, the health services business of the UnitedHealth Group and Merck, one of the world’s largest pharmaceutical companies collaborate to advance value-based and pay-for-performance contracting of pharmaceuticals. These companies are collaborating in order develop and simulate the performance of the contractual reimbursement models. In this reimbursement model, the payment for prescription drugs will be aligned to the patient health outcomes.
Optum and Merck collaborate to advance value-based contracting!
A multi-year collaboration is done between Optum and Merck, in which they will share ‘Learning Laboratory’. The companies will go to explore the pay-for-performance and value-based models, that will be known as OBRSAs (Outcomes-Based Risk Sharing Agreements). In this collaboration, they will even explore the potential for broad adoption of OBRSAs among health insurance companies, PBMs (pharmacy benefit managers), and pharmaceutical companies.
Outcomes-Based Risk Sharing Agreements!
Under OBRSAs, health plans and payers will go to reimburse the drug manufacturers based on the clinical outcomes achieved. The prices can fall or even rise depending upon the results, which will either succeed or fail in order to meet the expectations outlined in the agreement.
Across the health care system, OBRSAs have become part of the conversation due to the desire by PBMs, health plans, care providers, and pharmaceutical companies to base their reimbursements on the evidence-based outcomes.
How OBRSAs will be assessed?
The viability and applicability of these models will depend upon the measuring and monitoring of clinical outcomes, Optum’s integrated claims and clinical records will thus be used in order to provide data reflective of real world in the United States. And these data assets will then enable the companies to assess the OBRSA models across different clinical settings, patient populations, and therapeutic areas, which are aligned with Merck’s product portfolio.
Curt Medeiros, president of Optum Life Sciences said, ‘Ensuring that health care dollars are spent on interventions that improve patient care and a health outcome is a shared goal for all stakeholders’. He added ‘This collaboration offers an opportunity to leverage our collective strengths to increase knowledge about the design and implementation of outcomes-based contracts in the U.S. health system’.
Optum and Merck are now planning to publicly share the analytic insights, findings and even the recommendations in order to help inform and facilitate various understanding and use of pragmatic approaches to the OBRSAs in the health care system.
Susan Shiff, Senior VP, Center for Observational and Real-world Evidence, Merck said, ‘Our collaboration will create a unique data-driven platform to enable modeling and analysis of innovative contracts that are needed to move to a value-based health care model’. She added ‘The collaboration between Merck and Optum will help advance both organizations’ common goals of improving patient health outcomes, expanding access to innovative therapies, and ensuring the best use of health care spending’.
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Date: May 29,2017