FasterCures, a Center of the Milken Institute, recently released an important report that will be of great interest to those who are concerned with getting value-based innovations into the delivery system. Value and Coverage: How Reimbursement Decisions Impact Innovations Needed to Improve Health, articulates findings and recommendations from a workshop convened in July, 2013, at which I was pleased to participate.
Noteworthy in the report is the discussion regarding the determination of value and how coverage for innovation is viewed by the payer community.
For many years, I have stressed that new clinical interventions must be able to demonstrate value by improving the quality and cost-effectiveness of care delivery. As such, I was especially pleased by the following quote from Margaret Anderson, executive director of FasterCures: “At FasterCures, we view everything from the lenses of the cure system’s ultimate stakeholder – the patient. Getting a therapy to market is no longer the goal. We must also ensure that life-saving therapies are accessible and delivered to patients in a manner that is high quality and cost-effective.”
The report states that establishing safety and efficacy is no longer sufficient when developing a new therapy; innovators must also prove value to patients, providers, and payers in order to generate a revenue stream that covers their R&D costs and provides adequate profits to fuel the next discovery’s translation and commercialization.
The report outlines a series of recommendations specifically for patient organizations to consider. Recommendations fall under three major themes: collaboration; leveraging data; and deploying smarter, better care.
While the report details actionable items for patient organizations, it is critical for all stakeholders in this conversation – from payers to providers, academic scientists to industry executives – to recognize the value of engaging with the patient community and determine effective strategies for incorporating patient perspectives into decisions.
I urge you to read this report carefully.