AMCP Addressing Barriers to Value-Based Payment Models in Integrated Delivery Networks Advisory Group

Introduction:

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. Developed a lexicon to reduce the disconnect, misalignment, and lack of a common framework for value-based purchasing agreements, identified processes, systems, and methodologies critical for executing value-based contracts. Developed a communication resource.  

Resources Developed:  

• Talking the Talk: In the World of Value-Based Care, Words Matter: A Lexicon for Value-Based Purchasing 
  This lexicon provides a comprehensive overview of language used when discussing and designing value-based contracts across payers, provider systems, and manufacturers.  
• One-Pager: Lexicon: Value-Based Purchasing
  This one-pager provides an overview of the definitions of common terminology used by payers, providers, and manufacturers for discussing and designing value-based contracts. 

The work of this advisory group was supported by GSK, Lilly, National Pharmaceutical Council, Pfizer, PhRMA, and Spark Therapeutics.