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Outcomes-Based Contracting Experience: Research Findings from U.S. and European Stakeholders.

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|September 26, 2017
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Summary

Outcomes-based contracts (OBCs) are expected to triple in the EU-5 and grow moderately in the U.S. due to evolving healthcare landscapes. Simpler frameworks are key for future growth in these risk-sharing arrangements.

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Area of Science:

  • Health economics and outcomes research
  • Pharmaceutical market access strategies
  • Risk-sharing arrangements in healthcare

Background:

  • Outcomes-based contracts (OBCs) are risk-sharing arrangements (RSAs) enabling payer-manufacturer collaboration.
  • OBCs aim to improve patient access to medicines by linking reimbursement to real-world outcomes.
  • These contracts represent a shift towards value-based healthcare models.

Purpose of the Study:

  • To evaluate current outcomes-based contract activity and stakeholder perceptions.
  • To forecast future OBC trends from payer and manufacturer viewpoints.
  • To assess OBC outlook in the United States and the EU-5 markets.

Main Methods:

  • Conducted interviews with 27 experts: 14 U.S. payers, 5 EU-5 national payers, and 8 manufacturer executives.
  • Utilized the University of Washington's Performance Based Risk-Sharing (PBRS) database.
  • Supplemented data with targeted public information on OBCs.

Main Results:

  • Actual OBC activity exceeds publicly disclosed data due to confidentiality.
  • Stakeholders anticipate a 2-3 fold increase in OBC implementation over the next five years.
  • Key drivers include new national frameworks (Spain, UK), German sickness fund activity, and U.S. accountable care.
  • Operational feasibility presents a hurdle in the U.S. and France.
  • Payers prioritize cost reduction and risk mitigation; manufacturers seek enhanced access and reimbursement.

Conclusions:

  • Significant growth in OBCs is projected for the EU-5, with moderate growth expected in the U.S.
  • Development of clear and simplified OBC frameworks is crucial for sustained expansion.
  • Stakeholder input highlights the potential of OBCs to align incentives and improve healthcare value.