Value-based arrangements may be more prevalent than assumed.

Area of Science:

• Health economics
• Healthcare policy
• Pharmaceutical industry

Background:

• Value-based payment arrangements (VBAs) are evolving payment models in the US healthcare system.
• Understanding the prevalence and characteristics of VBAs is crucial for stakeholders.
• Factors influencing VBA success and barriers to implementation require investigation.

Purpose of the Study:

• To determine the prevalence of VBAs in the US.
• To characterize VBAs and identify facilitators and barriers to their implementation.
• To understand the perspectives of payers and biopharmaceutical manufacturers on VBAs.

Main Methods:

• Surveys administered to subject matter experts from payer organizations and biopharmaceutical manufacturers.
• Qualitative interviews conducted with a subsample of survey respondents.
• Descriptive statistics and thematic analysis of quantitative and qualitative data.

Main Results:

• A significant portion of respondents (5 payers, 1 manufacturer) had no VBA experience.
• Over 70% of VBAs implemented between 2014-2017 were not publicly disclosed.
• VBA implementation rates are low, with low conversion rates from dialogue to contract (approx. 33% for manufacturers, 60% for payers).

Conclusions:

• The majority of VBAs are not publicly disclosed, potentially underestimating their prevalence.
• VBA implementation faces challenges, with negotiation breakdowns differing by sector.
• Future VBAs may benefit from evaluative frameworks to guide desirability assessment and implementation.