How Changing to Outcome-Based Reimbursement Models is Better for Rare Disease Patients

Shifting Contracts

Over the years the United States healthcare system has shifted more toward reimbursement models that are outcome-based instead of service-based. In essence, this means that instead of paying for the therapy up front, agencies only pay for the therapy if it provides proven clinical benefits to patients. This type of model is also referred to as a risk-sharing model.

The shift to this new system has partly stemmed from the increasing development of novel therapies for rare diseases. Since these drugs are being developed for a very small patient population, they are extremely expensive. Since they are extremely expensive, payers are more hesitant than they normally are about buying. By providing buyers proof that the therapies are effective, the buyers are much more willing to sign a contract.

The Result

This change in models has actually proved very beneficial for rare patients because it has made pharmaceutical companies more diligent about ensuring their therapies work. Outcome-based contracts have been signed for therapies treating Multiple Sclerosis, osteoporosis, and Rheumatoid Arthritis among others.

With increased accountability on behalf of pharmaceutical companies, patient outcomes as a whole are significantly improving. Companies are now making more of an effort to ensure that they are doing everything in their power to help patients achieve significant clinical outcomes. This includes helping to make sure patients are adhering to their therapies and asking how they can provide additional support. Partly, this is achieved through patient service hubs which help to collect patient data, improve patient education, and increase overall patient support.

Patient Services Hubs

Not all patient service hubs are the same however. New studies on the matter have indicated varying effectiveness of patient support programs. This indicates it’s not enough to have a program in place, companies must ensure they are implementing the best type of program for their patient population. That said, the fact that these evaluations are now occurring at all displays a clear shift in priorities- all benefiting patients.

Some of these benefits which have stemmed from the increasing use of patient service hubs are a result of the fact that they-

  • Require patient follow-up
  • Ensure patient adherence
  • Work to close clinical data gaps
  • Can collect different forms of data such as quality of life, symptoms, overall satisfaction, and mental health
  • Ensure more frequent contact with patients (30, 60, and 90 day intervals after prescription)
  • Can keep track of patient data even as patients shift insurance plans
  • Help identify patients at risk for not responding to a therapy
  • Encourage increased patient engagement which has been shown to increase compliance

For example, a new Medication Therapy Management compliance program for leukemia showed that patients who participated in the program had higher medication possession rates than those who didn’t participate.

Overall, this shift in the type of pharmaceutical company contracts being used seems to be highly advantageous for the rare disease patient population. As new therapies are developed, we are seeing an increased commitment to ensuring these therapies are benefiting patients to their highest possible level. In the future, we will hopefully see this commitment only continue to expand.

You can read more about outcome-based contracts and how they’re changing the system for rare patients here.


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