The U.S. healthcare system can easily be described as one of the most complex in the world, with intertwining relationships between payers, providers and patients. While the medical community has made significant strides in developing breakthrough medicines, there is more work to do to ensure patients can access and pay for them. Stakeholders in both the private and public healthcare sectors are moving away from fee for service payment toward more value based care.
Many believe innovative payment models that tie the cost of medications to value could support more cost-effective healthcare and give patients access to groundbreaking treatments. This requires collaboration between the pharmaceutical industry and both private and public payers to reach agreements that could help address concerns about the cost of medicines while supporting continued biopharmaceutical innovation.
Thought leaders from across the healthcare industry recently gathered in Washington D.C. to share perspectives on this topic at a dinner event hosted by AstraZeneca in partnership with the National Journal, and moderated by Marilyn Werber Serafini, Vice President for Policy at the Alliance for Health Reform. AstraZeneca U.S. leadership team members were joined by 16 thought leaders and members of the media, representing organizations such as the American Medical Association, National Association of Medicaid Directors, American Association of Retired Persons, Cystic Fibrosis Association, the National Pharmaceutical Council and others.
Questions posed to the group throughout the evening included: What potential do innovative payment models hold for new medicines and other treatments? Which models currently being tested have the potential to become more widespread? What barriers are preventing widespread adoption of these models? What role should government play in this discussion?
Dave Fredrickson, Vice President of Specialty Care at AstraZeneca commenced the discussion by noting the challenges that currently exist within the U.S. healthcare system and highlighting AstraZeneca’s belief that innovative payment models that include pharmaceuticals play an important role in the continued evolution of the healthcare system from fee for service to value based approaches. Initial discussion circled around the definition of value and consensus quickly formed around value needing to be focused on the patient.
The discussion at times raised more questions than answers, as challenges around widespread implementation of innovative payment models appeared complex and multi-faceted. Potential solutions that surfaced included leveraging data and real world evidence to define and measure key metrics and implementing processes that foster competition within the industry while continuing to reward innovation. It was noted that though there may never be one single payment model that can be applied across the healthcare industry, disease-specific models may continue to emerge that have the most impact due to the varying needs of patients.
Diane Sullivan, Vice President of Market Access and Patient Strategies at AstraZeneca, summarized the evening, observing that despite the differences of opinion, everyone in healthcare is on this journey together and will need to work collaboratively to see which methods will result in the best outcomes for patients. Only time will tell which model(s) currently being tested will be most successful, as no dominant model has yet emerged that can address the far-reaching issues at hand.
The dinner was part of a series of events coordinated by National Journal LIVE, a premier events business that convenes top leaders in the Washington, D.C. area to discuss possible solutions to the country’s biggest challenges.