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Value-Based Contracting Services

Life science innovation and health care reimbursement models

The health care system is going through a volume-to-value transformation with the goal of controlling cost and improving patient outcomes with value-based contracting services and health care reimbursement models. At the same time, we are seeing tremendous innovation in new therapies that are being developed. The health care system is challenged with how to provide sufficient access to these new therapies while controlling overall health care spending.

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Value-based contracts: Improving patient access

Multiple stakeholders and the data hurdle

Value-based contracts (VBCs) and value-based care are promising ways to accelerate the shift from volume to value in health care. These arrangements between life sciences manufacturers (pharmaceuticals and medical technology) and payers and providers will play a critical role in enabling appropriate access to new innovations and tools for value-based care. They can improve patients’ health, by sharing risk across stakeholders and helping to control costs. Drug pricing will likely be a top priority for Congress in 2019, increasing the need for companies to demonstrate value.

While the number of publicly announced value-based contracts between life sciences companies and payers has increased over the past few years, there continues to be barriers preventing wider spread adoption. According to Deloitte’s 2018 real-world evidence (RWE) benchmarking survey, participants ranked challenges with collecting, linking, and analyzing data as the biggest hurdle, along with gaining stakeholder alignment and assigning value-based care to benefit.

If value-based contracts succeed…we might not need them anymore

How Deloitte can help with value-based contracts enablement

The right team. Demonstrated experience.

Deloitte has the breadth and depth of capabilities to help the health care and life sciences sector overcome these barriers. Our Value-based Care practice, repeatedly acknowledged by KLAS as the leader in our field, acts as a trusted intermediary for multi-stakeholder contracts. We take a healthy mix of cross-functional perspectives, from actuaries to data scientists, from industry consultants to technologists, to help facilitate the necessary shifts from volume to value-based care. Our approach outlined below entails value-based contracting strategy as well as operationalizing the arrangements in an end-to-end lifecycle.

Setting up for success

We help companies design their VBC strategies using:

– Product selection analysis: Which products are most suitable to value-based contracting?

– Cost/value analysis: What are the value drivers of each stakeholder and what value can be created within selected therapeutic areas?

– Customer targeting strategy: Who are the ideal stakeholders (e.g., large national health plans, regional plans, self-insured employers, integrated delivery networks) to target with a value-based contract deal and when?

VBC administration is complex

Many organizations lack the necessary infrastructure and resources to efficiently administer and adjudicate VBC arrangements for value-based care.

The ConvergeHEALTH platform is a secure, cloud-based big data environment designed to streamline the entire end-to-end VBC process. The platform can handle the most complex health care data, drives efficiencies and economies of scale for VBCs while instilling trust through transparency and objectivity.

Compiling the right information

ConvergeHEALTH Patient Connect aggregates patient data from multiple sources and connects all stakeholder data into a single view for all patient interactions. It helps enable adherence and care coordination, conduct digital therapy, improve patient outcomes, and support health care providers in managing patient care with the help of our regulated applications and devices.

VBC administrators can use internal and external data analysis to gather unique insights into patient treatment and interactions while demonstrating real-world evidence.

Navigating compliance

Deloitte can help you determine the best approach to structure the arrangement taking into account regulatory and compliance considerations, such as government best price implications, anti-kickback statue, and potential off-label promotion.

Leveraging a strategic position in the health care ecosystem

Deloitte serves the majority of top 10 global life sciences companies, many of the largest national and regional health plans, hospitals systems and provider networks, as well as government bodies and rapidly evolving pharmacy benefit managers and pharmacy players. Our position in the health care ecosystem provides us with a unique perspective and ability to bring stakeholders together.

Deloitte has now held two Value Exchange Summits in which nearly 30 participants representing health plans, health systems, pharmaceutical manufacturers, and patient organizations came together to address the core question, "How do we accelerate VBCs to positively impact patient outcomes and reduce health care’s overall cost?"

Participants brainstormed what is needed to make VBCs a reality from each stakeholder’s perspective, pragmatic approaches to overcoming hurdles to VBCs, and where to start in making VBCs mainstream. Linking value to life sciences treatments via patient outcomes is on the horizon. Drug pricing continues to be in the public limelight. Companies that pre-empt likely regulatory mandates and begin the transition now will be a competitive step ahead of those that lag.

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    Get in touch

    If you want more details about how Deloitte can help strategize, design, execute, and adjudicate VBCs while managing health care reimbursement models, we should talk.

    Joe Coppola
    Commercial Ops Practice Leader for Life Sciences
    Deloitte Consulting LLP

    Andy Davis
    Principal
    Deloitte Consulting LLP

    Jeff Morgan
    Managing Director
    Deloitte Consulting LLP

    Marcy Imada
    Principal
    Deloitte and Touche LLP

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