Value-Based Contracts Resources
Advancement in medications, vaccines, and gene therapies requires innovation in payment and reimbursement methods. New value-based and alternative payment contracts are increasingly implemented across a variety of health care plans, and pharmacy benefit managers and a range of care delivery providers are also engaging in these contracts. However, the types of conditions treated (e.g., rare vs. common diseases), the compliance and regulatory requirements, contractual terms, and risk/payment models used are complex.
AMCP Resources and Continuing Education
- Talking the Talk. In the World of Value-Based Care, Words Matter: A Lexicon for Value-Based Purchasing
Value-based contracts often require significant time to reach final negotiation and implementation. Disconnect, misalignment, and lack of a common framework for value-based purchasing agreements has exacerbated these challenges. This lexicon provides a unified language for discussing and designing value-based contracts across payers, provider systems, and manufacturers.
- AMCP Partnership Forum: High-Investment Medications
High-investment medications raise sustainability and affordability concerns for employers, payers, and patients. This Partnership Forum addressed payment and benefit challenges for high-investment medications and explored alternative payment reform, financial tools, and policy initiatives to improve the predictability, affordability, and accessibility of these treatments.
- State Model Legislation: Value in Pharmacy Care Act
AMCP developed the model state legislation to improve and modernize pharmacy benefit policy. Establishing standards for and expanding adoption of value- and outcomes-based contracts are key to improving care.
- Innovative Value-Based Contracting Approaches with Comprehensive Clinical Strategies
Innovative approaches to developing value-based contracts need to be multi-faceted. Value-based contracting requires measuring and assessing “value” as defined by patients, providers, pharmaceutical manufacturers, pharmacy benefit managers, and health plans. This online continuing pharmacy education program is accessible on AMCP Learn and offers 1.5 contact Hours. AMCP Member Fee: Free. Non-Member Fee: $30.
- Preventative Treatment for Alzheimer’s Disease and the Future Role of Value-Based Payment Arrangements
The current understanding of Alzheimer’s disease is evolving. Discuss considerations when using different types of value-based payment arrangements for early-stage treatments or preventive therapies for Alzheimer’s Disease. This online continuing pharmacy education program is accessible on AMCP Learn and offers 1.5 contact hours. AMCP Member Fee: Free. Non-Member Fee: $30.
- AMCP Partnership Forum: Integrated Delivery Network’s Role in Value-Based Agreements for Pharmacy and Medical Benefits
Implementing value-based reimbursement models for both pharmaceuticals and medical care poses significant challenges and opportunities and depends on integrated delivery networks (IDNs) to execute the processes and programs. This Partnership Forum convened industry thought leaders to discuss the issues.
- AMCP Partnership Forum: Designing Benefits and Payment Models for Innovative High-Investment Medications Partnership Forum
New health care innovations are bringing the promise of life changing treatment for specific diseases. Financial models for innovative, high-investment medications are needed to maintain patient access. This AMCP Partnership Forum brought together thought leaders in July 2018 to discuss the issues and solutions needed on this key issue.
AMCP Foundation: Value-Based Health Care for Patients, Providers & Payers — Summary from AMCP Foundation Research Symposium
AMCP Foundation webinar that discussed highlights from the 7th Annual Research Symposium.
Advancing Value-Based Contracting: Proceedings from the AMCP Partnership Forum Program
Value-based contracts (VBCs) have emerged as a mechanism that payers may use to better align their contracting strategies with broader changes in the health care system. This AMCP Partnership Forum brought together thought leaders in June 2017 to discuss definitions, performance benchmarks, best practices, and other action plans needed to advance VBCs.
Journal of Managed Care + Specialty Pharmacy (JMCP)
- Performance-Based Risk-Sharing Arrangements for Devices and Diagnostics in the United States: A Systematic Review
Performance-based risk-sharing arrangements have continued to emerge and evolve over the last 2 decades. To date, most of the attention and available literature have focused on pharmaceuticals. This JMCP review describes publicly available risk-sharing agreements for diagnostics and devices.
- Using the Delphi Method to Identify Meaningful and Feasible Outcomes for Pharmaceutical Value-Based Contracting
This Viewpoints article published in JMCP outlines an approach to more effectively align the interests of all key stakeholders and maximize the effect and transparency of value-based pharmaceutical contracts. The authors describe their experience using a validated Delphi surveying technique in five disease contexts to gather information and build stakeholder consensus on key elements before contract development.
Examining Misaligned Incentives for Payers and Manufacturers in Value-Based Pharmaceutical Contracts
This JMCP study compares pay-for-success and pay-for-failure models to identify the short- and long-term incentives that manufacturers and payers should consider when developing value-based contracts. More research is needed on the effect of different types of value-based contract schemes on cost and clinical outcomes.
Regulatory, Policy, and Operational Considerations for Outcomes-Based Risk-Sharing Agreements in the U.S. Market: Opportunities for Reform
Major reasons for the slow uptake of outcomes-based risk-sharing agreements in the U.S. are regulatory issues, operational requirements, and deficits in information sharing, according to a literature review published in JMCP.
Determination of Multiple Sclerosis Indicators for Value-Based Contracting Using the Delphi Method
This JMCP article describes using a Delphi method approach with patients, payers, providers, and pharmaceutical company and pharmacy benefits manager representatives to identify meaningful multiple sclerosis indicators and inform a value-based contract for these medications.