Using health outcomes data to inform decision-making: healthcare payer perspective

Healthcare payers are charged with the responsibility of achieving maximum profits or output within their limited budget. As the demands are always greater than the budget, there is growing interest in tools that can inform decisions on the allocation of limited resources. Healthcare payers are using health outcomes data to assist the decision-making process, although the way in which such information is being used may differ between payers. From the perspective of the French sickness fund, there is a need for real-world information to supplement the results of clinical trials and inform negotiations on pricing. In the US, the large databases of healthcare insurers are being examined in order to carry out retrospective cohort studies that go some way towards providing such real-world information on outcomes with alternative treatments. Another approach to health outcomes information has been taken by an Israeli healthcare organisation, Maccabi Healthcare Services, which introduced a disease management programme in order to improve outcomes of asthma management. Clearly, healthcare payers are using health outcomes information in a variety of ways to inform decision-making. The extensive databases available to payers may be used to good effect, to obtain real-life information that supplements clinical trial data and economic models of outcomes and costs, and to enable the targeting of interventions.