Reflections on the PCMA Annual Meeting
Total cost of care and value-based arrangements between manufacturers and payers is top of mind of HEOR and Medical Affairs leaders
November 2021
The Pharmaceutical Care Management Association (PCMA) convened hundreds of pharmacy benefit managers (PBM), payer and life sciences leaders together for its annual meeting in Colorado Springs.
Dr. Brian Solow, Chief Medical Officer of Optum Life Sciences, was among the many presenters and participants at the two-day event. He moderated a main-stage panel entitled, “Beyond the Value-Based Contract: HEOR and Total Cost of Care Reduction.”
Panelists included representatives from Optum Life Sciences, UnitedHealthcare and Boehringer Ingelheim Pharmaceuticals. For anyone who missed this well-attended session, I caught up with Dr. Solow to capture some of his big takeaways from the panel discussion and the larger PCMA event.
What was the most important message you wanted to convey during your session?
I want people to appreciate that value-based arrangements are part of a longer journey — they’re not just a destination.
Lisa Carman (Optum), Alex Hindman (UnitedHealthcare), Christine Marsh (Boehringer Ingelheim) and I wanted our audience to understand the step-by-step progression of our endeavor to align on value in ways that represent wins for the payer, the manufacturer, the physician, and most importantly, the patient.
The case study we discussed concerned a SGLT2 inhibitor for patients with Type 2 diabetes having concomitant cardiovascular disease. It all started with a robust clinical review and subsequent formulary placement.
This, in turn, ultimately led to a value-based contract (VBC) rooted in clear, measurable outcomes metrics.
From there, the manufacturer invested in additional analytics to drill into the outcomes of the VBC. How were patients taking this drug doing — from both a cost and outcomes perspective — relative to those not on this specific therapy?
The analysis revealed clear, measurable positive outcomes for patients taking this therapy. This was true both clinically and economically — those patients had a lower total cost of care (TCOC) over the period of time we measured.
Now, it’s important to note here that this particular therapy is recommended within national clinical guidelines for a meaningful subset of patients with Type 2 diabetes.
With analysis showing that the therapy truly lowered total cost of care within a small population, Optum worked with the payer in conversations about identifying patients who may benefit from this guideline-appropriate therapy across its entire commercial population.
This action was not about substituting one drug for another. This was about collaborating to identify and then close gaps in care, increasing the number of patients on guideline-compliant therapy regimens.
Based on the earlier analysis, closing these care gaps would benefit patients and lower the payer’s total cost of care.
This analytics-based approach took the concept of a value-based arrangement to a whole new level.
Beyond just proving value within the terms of the contract, we are on a course to identify and measure outcomes that matter to the various stakeholders. We’re working together to deliver value for the payer, the manufacturer and the patient.
I’ve been coming to this meeting for years. I love how PCMA always brings together leading thinkers from across the health care ecosystem, as well as from different parts of life sciences — market access, medical affairs, commercial, etc.
Dr. Brian Solow
What energized you most in sharing that story at PCMA?
I’m energized by the potential to apply this step-by-step approach to other drug classes and therapeutic areas. There’s no value-based contracting formula or checklist — each arrangement is unique.
But there are things we can learn about the process that should be broadly applicable. These include:
- Finding endpoints that are measurable and matter to all stakeholders
- Building trust and understanding each other’s point of view
- Starting with small pilots before rolling out to larger populations
- Leveraging real-world data and analytics to monitor and measure total cost of care impact
This clearly isn’t your first time at PCMA. What do you value most about this annual meeting?
I’ve been coming to this meeting for years. I love how PCMA always brings together leading thinkers from across the health care ecosystem as well as from different parts of life sciences — market access, medical affairs, commercial, etc.
With all these senior leaders in one place, you end up having meaningful conversations about the future of the PBM landscape.
This year, in particular, I enjoyed learning about some of the innovative new products entering the digital therapeutics space.
Along with new medical device companies, they’re asking sharp questions about how Optum Life Sciences may be able to help them figure out how they can demonstrate value to payers and potentially enter value-based arrangements of their own.
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