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Epsilon - Outcomes-based measurement: Redefining our approach to adherence


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Outcomes-based measurement: Redefining our approach to adherence

Do you take a patient-centric view of adherence success?
In today's changing healthcare environment, it's becoming increasingly important to define success based on our ability to provide better care, lower costs and improve patient outcomes.

In this infopaper, you'll learn:
• How outcomes are rapidly becoming the yardstick for industry performance in improving patient health
• The three critical pillars of an outcomes-focused program
• That shifting to this approach extends your brand's value to patients, providers and payers

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Epsilon - Outcomes-based measurement: Redefining our approach to adherence

  1. 1. June 2014 Outcomes-based measurement Redefining our approach to adherence A N E P S I L O N P E R S P E C T I V E HEALTHCARE
  2. 2. Introduction 3 The importance of health outcomes 4 Outcomes-based measurement 5 Redefining adherence programs 6 Epsilon recommendations 6 Conclusion 7 Contents
  3. 3. And in most cases, we measure the success of our promotional spending and these programs in terms of their ability to ensure that patients continue to fill scripts—which we take as a proxy for adherence to therapy. As a pharmaceutical industry, we collectively spend billions of dollars promoting therapies to patients to stimulate interest, intent, and ongoing product use. We run television ads. We launch branded and disease- awareness websites. We create complex, multichannel relationship marketing programs. Introduction But in today’s changing healthcare environment, it is becoming increasingly important for us to take a broader, more patient-centric view of success—one based on our ability to provide better patient care, lower costs, and improve patient outcomes. 16% 37% of health insurers have adopted new payment and contracting arrangements such as outcomes- based payments, risk-sharing agreements and bundled payments with pharmaceutical companies. of those who haven’t adopted new payment and contracting arrangements are expected to adopt them within the next three years. PwC Health Research Institute (HRI), 2012
  4. 4. The importance of health outcomes Healthcare outcomes are broadly defined as changes in a patient’s health status that can be attributed to the care he or she received. Achieving positive patient outcomes is the fundamental purpose of healthcare. Traditionally, outcomes-based initiatives have been the focus of provider networks, which today are being driven by policy and payers alike toward performance- measurement systems. New players such as Accountable Care Organizations (ACOs) are offering increasing incentives to provide quality care and better outcomes—and disincentives for failing to. Proponents argue that these systems discourage unnecessary treatments, keep people healthier, and reduce overall costs. The pace of change in the healthcare market is accelerating, and there is growing pressure on all stakeholders—healthcare systems, payers, policymakers, prescribers, and pharmaceutical companies to focus on value-based health outcomes. While sales and volume will continue to be key financial success metrics for in-line pharma marketers, outcomes will rapidly become the yardstick for how the industry as a whole is performing in improving patient health. Health outcomes will also increasingly drive formulary access, pricing, and reimbursement decisions. The ability to prove to patients that they are more than a script, to demonstrate positive patient impact to healthcare providers, and to show payers that a brand’s value extends beyond the clinical benefits of the drug will be the keys to success for pharma marketers in this outcomes-based world. McKinsey, 2013 Outcomes-based payment can reduce known sources of waste and inefficiency (redundant care, misuse, etc.), resulting in 10% or greater decrease in targeted spending. Merck agreed to peg what the insurer Cigna pays for the diabetes drugs Januvia and Janumet to how well Type 2 diabetes patients are able to control their blood glucose. In return, Merck got better placement for Januvia and Janumet on Cigna’s formulary.
  5. 5. Outcomes-based measurement Moving toward an outcomes-based approach requires that pharma take a different view of measurement. Companies must define the key outcomes against which they will measure success; identify practical and reliable methods to aid comparisons; and develop routine reports to showcase results. And for drugs in development, they will need to identify the relevant measures early enough to incorporate them in Phase III/IIIb trial designs. Primary outcomes measures may include total healthcare costs, incidence/prevalence of particular disease states, rates of specified diagnostic/therapeutic procedures, hospitalization rates, and productivity and quality of life measures. These may be determined based on the type of condition (e.g., chronic vs. acute) and the intent of the program (e.g., primary vs. secondary prevention vs. general wellness). Core data for these measures will need to be derived from a combination of proprietary and third-party sources including self-reported patient surveys, medical claims, and prescription sources. The level of rigor applied to program evaluation should balance feasibility and cost. A randomized control trial—gold- standard for clinical research—is not always possible. At a minimum, we must ensure that we are collecting patient-level information and measuring against a comparison group or baseline measure. We must also consider the duration of measurement—typically in 12-month increments—and plan accordingly.MEDICAL CLAIMS QUALITY OF LIFE PATIENT SURVEYS PRESCRIPTION SOURCES HEALTHCARE COSTS DISEASE-STATE INCIDENCE DISEASE-STATE PREVALENCE DIAGNOSTIC PROCEDURE RATES THERAPEUTIC PROCEDURE RATES HOSPITALIZATION RATES HOSPITALIZATION PRODUCTIVITY
  6. 6. Redefining adherence programs So how do we move toward an outcomes- based approach? We start by asking some simple questions: • Are our programs truly designed to improve a patient’s health? • Are we helping patients understand the risk factors associated with their conditions? • Are we providing targeted interventions designed to stimulate positive health behavior? • Does participation in our program result in better health, lower health costs, and increased productivity and quality of life? If we can’t answer those questions with a resounding, “Yes!” then we have some work to do. The challenge is not insurmountable, but it does require a shift in perspective and a new toolset. In 2011, Cigna initiated a partnership with EMD Serono designed to reduce relapses in MS patients—adverse events that cost the health plan up to $11,000 per hospitalization. Cigna/EMD are tracking the percentage of hospitalization and emergency room visits avoided by people using Rebif to convincingly demonstrate that any increased drug spend is offset by improved clinical outcomes and decreased costs-to-treat. Develop a health assessment strategy. Allow patients to better understand their current health status and to identify potential near- and long-term health risks. Create a risk stratification plan. Group patients into meaningful risk-based categories that allow the program to target relevant, timely, and actionable content, tools and resources. Design segment-specific health management intervention tools. Help patients understand, navigate, manage, and coordinate the healthcare resources available to them, and enable them to become proactive and engaged managers of their own health. 1 2 3 Planning for any outcomes-focused program should incorporate three critical pillars: Epsilon recommendations
  7. 7. Conclusion A mounting body of evidence demonstrates that patients who are actively engaged in their own healthcare will experience better outcomes and incur lower costs. Active engagement incorporates two key concepts: • The patient’s willingness and ability to manage his or her own health and care, and • The empowerment of that willingness and ability with targeted interventions designed to promote positive patient behavior. If we can make the shift to thinking about adherence programs as tools to enable the good of patients—not just to secure additional refills—we will be able not only to measure our success in improved health outcomes, but to meet the new challenges of our changing healthcare system.
  8. 8. Epsilon is the global leader in creating customer connections that build brand and business equity. A new breed of agency for a consumer-empowered world, our unique approach harnesses the power of rich data, world-leading technologies, engaging creativity and transformative ideas to ignite connections between brands and customers, delivering dramatic results. Recognized by By Bruce Grant, SVP/Strategy, Epsilon Healthcare A veteran with more than four decades in healthcare marketing and digital business strategy, Bruce currently serves as Senior Vice President of Strategy for Epsilon’s Healthcare Portfolio. In this capacity, Bruce offers evidence-based strategic counsel to Epsilon clients, internal teams, and partner companies, as well as development of new offerings to meet the changing needs of healthcare marketers. Ad Age as the #1 U.S. Agency from All Disciplines, #1 World Largest CRM/Direct Marketing Network and #3 Largest U.S. Digital-Agency Network, we employ over 5,000 associates in 60 offices worldwide. Epsilon is an Alliance Data company. For more information, visit, follow us on Twitter@EpsilonMktg or call 800.309.0505. About Epsilon Our approach Creating effective connections that drive tangible business results
  9. 9. 800.309.0505 | | Copyright © Epsilon 2014 Epsilon Data Management, LLC. All Rights Reserved