Performance-based risk-sharing agreements in renal care: current experience and future prospects

Area of Science:

• Health economics
• Health services research
• Medical technology assessment

Background:

• Performance-based risk-sharing agreements (PBRSAs) are valuable tools when the cost-effectiveness of new health technologies is uncertain.
• These agreements, involving payers, providers, and manufacturers, can be complex to design and implement effectively.
• Existing PBRSAs primarily focus on national-level, provider-payer pay-for-performance schemes.

Purpose of the Study:

• To explore the potential and challenges of PBRSAs in healthcare.
• To identify opportunities for PBRSAs, particularly at the local level between providers and manufacturers.
• To illustrate the application of PBRSAs through hypothetical case studies.

Main Methods:

• A comprehensive literature review was conducted to identify existing PBRSAs.
• Analysis of 18 identified agreements to understand their structure and scope.
• Development of hypothetical case studies to demonstrate potential PBRSA applications.

Main Results:

• The literature review identified 18 PBRSAs, predominantly national-level pay-for-performance agreements between providers and payers.
• No examples of local-level agreements between healthcare providers and manufacturers were found.
• Hypothetical case studies highlighted the potential of local PBRSAs in areas like water quality and chronic kidney disease management.

Conclusions:

• PBRSAs offer advantages for patients, providers, payers, and manufacturers, especially in introducing novel technologies or care systems.
• Significant challenges exist in the design, conduct, and implementation of PBRSAs, particularly within renal care.
• Addressing these challenges is crucial to ensure broader patient access to technological advancements and innovative care models in renal medicine.