Payer Perspectives: The Importance of Collaborations for Health Care Expenditures

According to a recent poster at AMCP Nexus 2020, collaborations, especially those that focus on disease-related research and lowering health care costs, payers are becoming increasingly interested.

“In the context of rising expenditures and shift from volume-based to value-based healthcare payment and delivery, payers are focused on improving member outcomes and decreasing costs,” researchers wrote. “Aligning these priorities allows stakeholders to engage in mutually beneficial collaborations.”

The research team explained that in order to understand the themes and key steps to establish successful, non-contractual collaborations between payers and biopharmaceutical manufacturers, who play key roles in supporting the shift to increasing value, an online survey was conducted from November to December 2019. It was distributed to a panel of managed care professionals, and those who had direct involvement with a manufacturer were asked to describe their experiences, barriers to implementation, elements of successful partnerships, and priorities for future opportunities.

There were 31 participants who completed the survey. The participants were mostly comprised of pharmacy directors (74%) and representatives of health plans (49%), and 45% of the respondents had a role in 3 or more collaborations with manufacturers.

According to the findings, respondents collaborated with manufacturers for:

• patient education materials (55%);
• clinician education resources (52%);
• quality measure improvement programs (52%); and
• formulary pull-through resources (52%).

Of note, 84% of the collaborations reported focused on a single disease state and 32% focused on a single medication. They did highlight however, that for future collaborations, the most commonly chosen disease are to focus on was oncology (71%). The next two disease states included cardiovascular diseases (65%) and endocrinology (61%).

 “Over half (58%) of respondents indicated that their organization’s interest in collaborating with biopharmaceutical manufacturers has increased over the past 5 years,” the researchers wrote. “Respondents were very interested in programs focusing on reducing unnecessary healthcare expenditures (90%).”

The researchers found that the 68% of the participants were interested in future collaborations on research projects.

Finally, of important note, 74% of respondents said that a lack of funding was identified as an obstructive primary obstacle and barrier for collaborations.

“Payers are increasingly interested in collaborations, especially ones focusing on disease-related research and reducing healthcare expenditures,” the study team concluded. “By aligning priorities, payers and manufacturers can collaborate to improve patient outcomes, lower costs, and increase patient access.”

—Julie Gould  

Reference:

Louie DL, Yan A, Gaiser AS, Weber S. Evaluation of Payer-Manufacturer Collaborations: Priorities, Barriers, and Characteristics of Successful Partnerships. Poster U9. AMCP Nexus 2020.