There are operational challenges associated with outcomes-based contract, but 70 percent of health plans reported having positive attitudes toward them. Twenty-four percent of health plans report outcomes-based contracts, with 12 percent saying they are contracting with more than five. Another 30 percent of health plans report they aren’t participating in outcomes-based contracts right now, but are in ongoing negotiations for one or more.
“Health plans, providers and patients demand innovative, data-based methods to improve outcomes and manage cost,” said Avalere President Dan Mendelson. “Outcomes-based contracts offer the opportunity to deploy data, analytics and interventions to deliver on these goals for pharmaceuticals — particularly to better integrate therapy into medical management.”
The report surveyed health plans in the United States from April 11 to May 1 with an online platform.
Here is the breakdown of payers with outcomes-based contracts by specialty:
1. Endocrine: 55 percent
2. Infectious disease: 45 percent
3. Cardiovascular: 42 percent
4. Respiratory: 41 percent
5. Immune/inflammatory disease: 24 percent
6. Orthopedics: 15 percent
7. Rare/orphan disease: 5 percent
8. Oncology: 5 percent
The breakdown of health plans considering contracts by specialty include:
1. Endocrine: 33 percent
2. Infectious disease: 29 percent
3. Cardiovascular: 30 percent
4. Respiratory: 29 percent
5. Immune/inflammatory disease: 39 percent
6. Orthopedics: 35 percent
7. Rare/orphan disease: 12 percent
8. Oncology: 30 percent
“While some plans have experienced administrative and operational challenges in implementing outcomes-based contracts, most are figuring out ways to benefit from these types of contracts in multiple therapeutic areas,” said Kathy Hughs, vice president at Avalere. “Solutions in data connectivity, contract monitoring and direct clinician intervention streamline the administrative burden and enable transparency for all parties.”
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