There is a dynamic interplay between health economics, patient-centricity, and value assessment—an intersection that holds the key to unlocking better health outcomes, improved access to care, and sustainable healthcare systems. With the principles of health economics guiding our decision-making processes in healthcare, we can allocate resources effectively and maximize the value delivered to patients. Patient-centricity lies at the heart of this convergence, emphasizing the importance of putting patients and their unique needs at the forefront of healthcare delivery.
Despite decades of investment in patient-centered health care, decisions about access and value are typically made in the context of financial risk management, and often without the input of those who should benefit from care. In addition to a myriad of payment reform strategies, rising interest in cost-effectiveness evaluation commands a central place in the debate about how to measure and pay for high-quality, efficient, and equitable health care.
This week on the Race to Value we are joined by Dr. Jason Spangler, the Chief Executive Officer for The Innovation and Value Initiative (IVI). The IVI is a collaboration of scientists, patient organizations, payers, life sciences companies, providers and delivery systems dedicated to finding scientifically credible approaches to measuring value in healthcare. The IVI provides the technical knowledge, resources, and collaborative learning platform that facilitate exploration and application of value-based care. In this podcast episode, you learn how partnership with patients, researchers, and industry and purchaser stakeholders can build consensus on the scope and inputs needed for value assessment models. Only by assessing true value in health care will we win the Race to Value!
04:30 Creating open-source models that allow researchers and decision-makers to explore, apply, and test scientifically credible approaches to measuring value in health care.
05:30 “The IVI is a nonprofit research organization that focuses on the science and the methodology for determining value, new medical technologies, and innovations.”
06:00 Health technology assessments (HTA) typically have only included payer perspectives (not the patient perspective!)
07:30 Going beyond the academic research understanding of value assessment to reflect real world patient experience.
08:00 How is patient-informed value assessment and comparative effectiveness research used to impact health policy at a national level?
11:00 Defining “value” from a health economist perspective provides the standard equation.
11:45 What is important to patients beyond the clinical outcomes – these must be measured too!
12:30 The costs of healthcare beyond the financial domain (e.g. time, future prospects, family) forces us to deviate from the simple value equation.
12:45 The “Value Flower” – the elements of value that are important to all stakeholders (e.g. QALYs Gained, Net Cost, Productivity, Equity, Hope, Knowing, etc.)
14:00 Asking patients what is important to them in the formation of specific patient-reported outcome measures.
15:00 “We typically look at cost effectiveness in terms of patient populations and averages. This must be balanced with individual patients or smaller patient communities.”
15:45 How good are we…really…in actually listening to patients? Fee-for-service care complexity gets in the way of meaningful connection.
17:00 Using both qualitative and quantitative data to advance patient-centered innovation.
17:30 The IVI is driving innovation in value assessment through the Open-Source Value Projectwhich is a laboratory for advancing the science and improving the practice of value assessment in the U.S.
19:30 Guiding Principles for Value Assessment in the U.S. (e.g. Patient-Centricity, Transparency, Equity, etc.)
21:00 Identifying specific disease conditions in the creation of an open-source value assessment.
22:30 Innovation in the science and research of developing new value assessment models ( e.g. pharmacologic and non-pharmacologic interventions of major depressive disorder).
23:30 Innovation in the development of models for rare diseases.
24:45 “If we are really serious about being patient-centric, we have to stretch the bounds of how we look at value (beyond just cost effective analysis or budget impact).”
27:30 Dr. Spangler discusses how health economists drove the development of the Value Flower construct.
29:45 “Having a value-based healthcare system is not as important as having a patient-centric healthcare system. Value flows from patient-centeredness.”
30:00 The “Value Spillover” as an opportunity to look at innovations more specifically, beyond the immediate benefits of healthcare interventions beyond their primary targets.
32:00 Health Equity and SDOH as spillover effects from value-based health care interventions.
33:00 Creating a learning health system to drive value-based innovation.
34:30 The Gartner Hype Cycle has all to often become the reality of what many expect from innovative technologies and interventions in healthcare.
36:00 IVI was created to address the lack of patient-centered health technology assessment (HTA).
36:30 HTA in other countries often results from the fiscal planning requirements of government-led healthcare systems.
38:00 The complexity of having a hybrid public/private healthcare system when developing a patient-centered HTA model.
39:00 Lessons learned from HTA models in other countries.
41:00 Incorporating Value Flower dimensions into the science of HTA.
42:45 Medicare Drug Price Negotiation is an opening for the U.S. to influence health policy through HTA.
45:00 The IVI Health Equity Initiative — a 2-year initiative that aims to define gaps in value assessment practice as it relates to health equity.
46:00 Taking a leadership role in catalyzing action for the development of methods in value assessments that promote equity.
46:45 “There is no value without equity. They are so intrinsically intertwined that you can’t have one without the other.”
47:30 Changing the core of HTA to incorporate Equity – It requires redesign of the fundamentals, stakeholder accountability, and the adjustment of power structures.
49:00 Equity as a collective responsibility that requires meaningful engagement between stakeholders.
49:30 Don’t wait to address health equity until you have perfect data and be willing to use a mixed method approach (both qualitative and quantitative).
51:30 The need to ensure that clinical trials have more diverse populations.
52:00 Creating a diverse patient advisory group to advise health plans on benefit design and community support models.
53:30 Stakeholder accountability mechanisms to advance health equity.
54:00 A leading example: the work CMS is doing to advance Health Equity.
54:30 Americans owe nearly $195 million in medical debt, and these financial burdens are worse for middle aged and BIPOC people dealing with chronic diseases.
55:00 IVI and AcademyHealth recently partnered to develop a research framework to address the full range of economic impacts on patients and caregivers.
56:00 The role that the Patient-Centered Outcomes Research Institute (PCORI) has played in cost and cost-effectiveness analysis.
58:00 Jason discusses the importance of assessing economic impacts in the consideration of health outcomes.
59:00 “Our health is not just direct medical care. And our health costs are not just related to direct health care costs.”
59:30 The overlap of non-medical economic impacts and health equity on health outcomes.
61:00 Prioritizing needs of families beyond just care planning and treatment.
62:30 Implementing effective health policy to affect change on the economic impacts of health (e.g. aligning incentives and creating public-private partnerships).
65:45 Parting thoughts on the importance of collaboration to reshape American healthcare in solidarity with one another.
69:30 Overcoming polarization through the willingness to listen to opposing views – we are all allies in wanting a better healthcare system!
72:00 Find out more about IVI online or social media! Feel free to email Dr. Spangler directly if you have questions.