1. UK0648 IMSPP Value poster S07_Layout 1 14/04/2010 11:31 Page 1
Speaking of Value in Healthcare: The Need for Common Understanding of Terminology
SHELLEY REICH AND NATHAN WHITE
PAREXEL MEDICAL COMMUNICATIONS AND PAREXEL CONSULTING/REIMBURSEMENT AND MARKET ACCESS SERVICES
Background Objectives Definitions of value terminology 1750
1750
G In this era of increasing demand for economic demonstrations of value, it is G Identify and determine frequency of use of specific terms that are used to convey A
important to understand the extent to which health-economic information is health-economic information and value in peer-reviewed medical journals. Comparative Effectiveness (Research)
G Research evaluating and comparing health outcomes and the clinical effectiveness, risks, and
Percentage
being incorporated into clinical papers and review articles—and how these 2864
G Define specific meanings for terminology within the context of evolving 3000 benefits of two or more medical treatments, services, and other items.3 44
terms are being used to convey value. 50
healthcare forces and trends.
G Multiple forces are driving changes in how value in healthcare is 2500 Cost Effectiveness
G Relate how this terminology can be used to effectively and consistently to 2208
demonstrated: G Term used to describe how much a drug or treatment costs per Quality Adjusted Life Year
-7
communicate value and enhance impact to wider stakeholder audiences. -16
Totsl number of occurances
(QALY), or $/QALY.
– Greater focus on healthcare quality 1
2000 0
G Can also be stated “cost of using a drug or treatment per year of the best quality of life available”.4
– Impact of healthcare reform
Cost Comparative Reimbursement Coverage
– Greater regulatory scrutiny of healthcare costs and pharmaceutical
spending
Methodology 1500 Reimbursement
G Compensation for healthcare products or services delivered, usually at a pre-determined rate
effectiveness effectiveness
G Four commonly accepted terms for communicating health-economic according to the complexity and cost of a product or service. Figure 5. Per cent of increase of occurences from 2006 to 2009 in core clinical journals
– Demand for evidence-based medicine to better understand the 1000
G Reimbursement can be subdivided into:
information and value were identified:
comparative effectiveness of treatments.2 508 – Provider reimbursement (divided by settings of care such as pharmacy, outpatient, long-term
–
–
Comparative effectiveness
Cost effectiveness
500
183
care, and hospital).
– Patient reimbursement (for certain settings of care, insurance scenarios or elective procedures).
Summary of findings
– Coverage G There is an increased trend toward the use of health-economic and value
0
Coverage terminology in all journals and core clinical journals.
OLD DEFINITION NEW DEFINITION – Reimbursement. Cost Comparative Reimbursement Coverage
G Term used in the insurance industry to mean amount and type of insurance; in healthcare the
effectiveness effectiveness G Of the four identified terms, cost effectiveness appeared most frequently in
G A systematic search of PubMed was conducted analyzing the frequency of use term has a more ambiguous meaning, but generally refers to assurance for reimbursement by a
payer for a product or service provided. all journals and core clinical journals, and comparative effectiveness
• Comparative effectiveness research: 2009 of these terms from 2006 to 2009. Search terms were limited to all journals
• Comparative clinical effectiveness research B G Coverage can be subdivided into: showed the most significant increase in core clinical journals.
HEALTH listed on PubMed, core clinical journals, and the following therapeutic
– Patient insurance coverage level (benefits such as medical/pharmacy/hospital/catastrophic, G There is an observed lack of consistency in the use of health-economic terms
Clinical efficacy POLICY Cost effectiveness
categories: primary care, oncology, cardiology, and neurology (limitations of
benefit limitations, co-insurance and deductibles)
CHANGE research design: Since only a quantitative search was conducted, titles with 400 380 within the context of evolving healthcare value terminology.
Safety – Product coverage (formulary inclusion and tier placement).
search terms were randomly selected to observe usage).
350
VALUE Reimbursement
300
A
Conclusions
Results
Totsl number of occurances
coverage Other 959 46 189 601
247
250 Oncology 259 87 658 G Better understanding and more consistent use of terminology will lead to
Tactics for defining value
• Randomized controlled trials (RCT) Neurology 280 26 179 better communication among stakeholder groups.
• Patient-reported outcomes Cost effectiveness Comparative effectiveness 200
Primary care 1025 83 167 659 G More research is needed to understand how clinical audiences are using
• Registries 120 116 Reimbursement Coverage
• Health technology assessment 150 Cardiology 341 37 39 111 health-economic terminology to demonstrate value.
• Economic model 97 0 20 40 60 80 100
100 G More research is needed to understand how payer audiences are
• AMCP/Value dossier 85 100 Cost effectiveness Comparative effectiveness Reimbursement Coverage
82 B perceiving the use of health-economic and value terminology in core clinical
Number of occurances
58
80 45
69 50
Other 13 12 13 45
journals.
Figure 1: Defining value 60 62 Oncology
56 6 6 50
60 0 Neurology 10 2 10
References
Cost Comparative Reimbursement Coverage 1. McGlynn, EA, Asch, SM, et.al.The quality of health care delivered to adults in the United States.
35 Primary care
G Definitions of value terminology are changing. 40 effectiveness effectiveness
103 44 20 103 N Engl L Med. 2003: 348(26):2635–45.
Cardiology 72 2 7 72 2. Institute of Medicine. 2007. Learning What Works Best: The Nation’s Need for Evidence on Comparative
G This trend is affecting medical publication planning, creating a need to 16 Effectiveness in Health Care. http://www.iom.edu/ebm-effectivness.
20 9 9 0 20 40 60 80 100
reach much wider audiences, including stakeholders from: Percentage
3. United States Congress, Patient Protection and Affordable Care Act of 2010.
2 5 14 13
– Managed Care (Commercial and Government Payers) 0 Figure 3(A). Value terminology: total number of occurrences in all journals, 4. National Institute For Health And Clinical Excellence,
2006 2007 2008 2009
Figure 4(A). Value terminology: total number of occurrences by therapeutic category
http://www.nice.org.uk/newsroom/features/measuringeffectivenessandcosteffectivenesstheqaly.jsp.
– Health Economics and Outcomes Research (HEOR) 2006–2009 in all journals, 2006–2009.
– Health Technology Assessment (HTA) Figure 2. Value terminology: number of occurrences of term by year in core clinical Figure 3(B). Value terminology: total number of occurrences in core clinical journals, Figure 4(B). Value terminology: total number of occurrences by therapeutic category
– Health Policy and Regulatory Bodies. journals, 2006–2009 2006–2009 in core clinical journals, 2006–2009
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