ARE YOU CHOOSING THE RIGHT
PARTNER TO HELP MINIMIZE RISK?

 

Innovative contracting based on financial risk sharing is increasingly becoming the new norm in the marketplace, with patient outcomes being a key standard by which drug pricing is determined.

Minimizing risk in the design and execution of such contracts requires a careful consideration of the factors contributing to risk and a keen focus on the role providers play in optimizing patient outcomes. Inherently, manufacturers bear the risk associated with drug performance, and this can lead to lower revenues if little or no improvement in patient outcomes is observed.

This being said, many factors contributing to drug performance are difficult to control and measure, such as:

  • patient adherence
  • timely side effect management that keeps patients compliant with a prescribed drug regimen
  • the extent to which evidence-based guidelines are being used
  • whether there is appropriate follow-up of patients to monitor progress and symptoms, which includes laboratory testing
  • whether payers are in any way restricting access to care

 

Improving patient outcomes can be a daunting task if systems are not in place to capture, share, and report data appropriately; data is currently scarce for many of the above considerations.

What helps to minimize risk associated with risk-share and other innovative contracting is to validate data at prespecified time points during the execution of a contract. Not surprisingly, the resources and/or tools needed to analyze and validate such data in a manner that satisfies agreed-upon performance benchmarks may not exist in either contractual partner. In such cases, partnering with external resources is vital to ensuring the success of an innovative contract with payers. Scott Adams, creator of Dilbert, once said, “Losers have goals and winners have systems.”

Aventria Health Group has taken an innovative and proprietary systems approach to helping drug manufacturers collect samplings of the HIPAA-compliant patient data being reported by payers at contract end in order to lend insight into its validity as well as offer the opportunity for midcourse corrections.

In partnership with pharmaceutical clients, Aventria embeds a CareCart into the electronic health records systems of key providers in the contract region to help capture data relevant to the performance benchmarks of an innovative contract as well as optimize clinical decisions. By focusing on key providers whose patients are representative of a payer’s member population, Aventria Health Group helps drug manufacturers gain insight into provider-level factors important to patient outcomes, such as prescribing behavior, patient follow-up, and side effect management.

CareCarts, in various forms, have been installed in a broad cross-section of provider organizations across every state in the country, many of whom have multiple sites of care. Because providers are asked to participate in the design of these CareCarts, drug manufacturers and organizations benefit from the consistency in approach to patient care and the added value being provided to patients.

For example, if the innovative contract depends on outcomes, and outcomes depend on adherence, then the CareCart is designed in conjunction with providers to help them improve adherence. Using the latest behavior science, patients are counseled on the importance of adherence in the management of their disease and about office appointments or required laboratory testing. They are also encouraged to report side effects via HIPAA-compliant text messages and/or email so that providers can act quickly to manage side effects before they adversely impact adherence.

In great part, its systems approach to meeting client needs is what sets Aventria Health Group apart and why dozens of pharmaceutical companies partner with them to ensure the success of their innovative contracts with US payers.

Aventria Health Group also provides a full continuum of services and capabilities—from market access strategies to technological innovations—that facilitate brand pull-through. An unmatched combination of expertise and creative innovation fuels growth and helps clients achieve their business objectives.