What have you learned so far to help you address some of these challenges?
We’ve learned that it takes a long time to fully assess gene therapy outcomes and get to a full picture. These contracts and studies require a thoughtful, big-picture approach, so it’s important to work through the analysis with manufacturers prior to approaching a health plan; this way, manufacturers can see what the data look like and let that inform their approach to the VBC.
Optum can identify and track patients who have received cell or gene therapies and consistently monitor the success or failure of these therapies. Our technology will allow reporting on long-term patient outcomes to support VBCs, even in the event that a patient changes health plans.
What are some other ways your team is leveraging Optum data and analytics to support manufacturers with cell or gene therapies?
We use claims and clinical data to identify analytic populations of patients who might be eligible for gene therapies in order to describe the current cost of care and burden of illness. We can see how clinicians diagnose and treat patients with rare diseases today; this helps us determine potential metrics, like a specific lab or test, that can support VBCs. These metrics can also help manufacturers figure out if they need to educate clinicians or change provider behavior in order to ensure those critical metrics get captured at the right times. Our team creates data models for this type of work, too, so that we can look at potential scenarios and help design win-win contracts between payers and manufacturers.
How did your session fit into the larger Gene Therapy for Rare Disorders Conference?
A handful of other sessions had real-world data themes like ours. It was a great conference to attend because of the breadth of topics — there are so many innovative therapies in the development pipeline. One of my favorite parts about attending these events is simply getting to be with others who are passionate about this topic. There’s so much being done — which is why it’s important for Optum to be a part of the rare disease community and have a voice in all these important conversations about bringing innovative cell and gene therapies to market.
- - - - - - - - - - - - - - - - - - - - - - - - -
To support patient access, we need to track outcomes the right way. This means choosing the right metrics that are routinely captured by providers and following patients for long periods of time. The work that Erin and the rest of our VBC and HEOR teams are doing will help manufacturers — and all health care stakeholders — create agreements that help providers deliver appropriate, cost-effective treatments to patients who need them most.