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Josh Seidman, Avalere Health, at the 2016 DiabetesMine Innovation Summit

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Josh Seidmen, Senior VP at Avalere Health, presents on “Value-Based Care & Patient Engagement: Progress and Interplay” at the 2016 DiabetesMine Innovation Summit at UC San Francisco Mission Bay on Friday, Oct. 28.

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Josh Seidman, Avalere Health, at the 2016 DiabetesMine Innovation Summit

  1. 1. Value-Based Care & Patient Engagement Avalere Health | An Inovalon Company October, 2016 Josh Seidman, PhD, Senior Vice President Avalere Center for Payment & Delivery Innovation
  2. 2. 2 Diabetes Management in a Value-Based World Volume and Market Share Value, Efficiency, and Effectiveness FEE-FOR-SERVICE PARADIGM NEW VALUE PARADIGM
  3. 3. 3MIPS: Merit Based Incentive Payment System; Source: CMS. MIPS/APM Proposed Rule. Date Accessed: Jun. 13, 2016. New Medicare Payment System Creates Incentives for Improved Diabetes Management Performance Categories Weighting – 2019 and 2021 Payment Years 60% 25% 15% 0% Quality Advancing Care Information Improvement Activities Cost Performance 30% 25% 15% 30% 2019 2021
  4. 4. 4 New Medicare Payment System Creates Incentives for Improved Diabetes Management Advancing Care Information (25%) Clinical Practice Improvement Activities (15%) • Patient Access • Care Coordination • Clinical Decision Support • Shared decision making • Population Management • Care Coordination • Patient Engagement
  5. 5. 5 New Opportunities for Evidence-Based Diabetes Management Programs Telephone-based health coaching improves adherence Self-management education programs are cost effective Poor communication and lack of coordination cost $25-$45 billion/year
  6. 6. 6 Patient Engagement and Diabetes Management “People with long-term chronic conditions spend 99 percent of their time outside of the health care system. What they do with that time determines their quality of life, their health and also their utilization of the health care system.” – Kate Lorig, Director, Stanford Patient Education Research Center
  7. 7. 7 Active, Engaged Patients Have Better Clinical Outcomes Better Shared Decision Making Lower Readmissions Higher Quality Care Improved Care Transitions More Confidence Better use of Preventive Care Improved Adherence High Patient Engagement
  8. 8. 8 Efforts to Assess Value Are On The Rise 2011 2012 2013 2014 2015 2016 Comparative- Effectiveness Research • Patient-Centered Outcomes Research Institute (PCORI) Value Frameworks • American Society of Clinical Oncology • European Society for Medical Oncology • National Comprehensive Cancer Network • Memorial Sloan Kettering • Institute for Clinical and Economic Review’s Emerging Therapy Assessment and Pricing Program Principles for Value Assessment • National Health Council • National Pharmaceutical Council • PhRMA Patient-Perspective Value Framework
  9. 9. 9 These Frameworks Don’t Measure Value from the Patient’s Perspective “The [ASCO] tool as designed does not provide patients with the information they need to make informed treatment decisions” – American Cancer Society Cancer Action Network “The Cancer Support Community would like ICER to utilize a framework which more closely represents the endpoints that are meaningful to patients” -- Cancer Support Community “We are concerned that the communication of a net health benefit score will not improve the strength of the shared decision- making process” – National Coalition for Cancer Survivorship
  10. 10. The Patient-Perspective Value Framework 10 PATIENT PREFERENCES PATIENT- CENTERED OUTCOMES PATIENT & FAMILY FINANCIAL CONSIDERATIONS APPLICABILITY& CONSISTENCY OFEVIDENCE USABILITY & TRANSPARENCY Avalere, FasterCures, and a Broad Group Of Stakeholders are Partnering in this Effort
  11. 11. 11 The PPVF Will Have Many Potential Applications Draft PPVF _____ Criteria, data and methods to measure the Patient’s Perspective on Value Shared Decision Making Apply to Existing Frameworks Support CMS Programs Condition- Specific Public Analyses APPLICATIONS TO INFORM FUTURE VERSIONS OF PPVF
  12. 12. 12 Thank you Josh Seidman, PhD Senior Vice President Avalere Health Center for Payment and Delivery Innovation jseidman@avalere.com www.avalere.com @jjseidman

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