The Power of Data in Enhancing Value-Based Care

At the NASP Annual Meeting in Texas last month, I joined our friends from Highmark and Inovalon on a panel to discuss the use of data in enhancing patient care and cost management efforts. Specifically, we dove into ways specialty pharmacy providers can take advantage of value-based opportunities that health plans are bringing to market. Here are some key insights for specialty providers eager to engage in value-based care (VBC). 

You need to find the right partners to deliver the right capabilities so that you are ready to execute when value-based opportunities are made available.  

The trick to engaging with and excelling at VBC is to have the right combination of knowing what you want to be good at and creating the operating model to execute in that area, whether it be a specific therapeutic category, a dedicated offering like rare and orphan products, an integrated system specialty operation, or a generalist specialty clinical practice.  

Engaging partners that deliver you the right technology to make you smarter (patient level data augmentation), more efficient and organized (workflows and processes), and more accessible (program and network access) will help ensure that you can be ready to execute on a value-based patient management opportunity when it shows up at your door.  

Assembling the right team can ensure you are capable and ready.  

The ‘right opportunity’ is likely the first opportunity. 

While it’s important to be discerning when engaging in a value-based arrangement to ensure that it’s something that fits with what you want to be good at, it is similarly important to not wait too long for the perfect opportunity. Often times, delivering on a reasonable opportunity will beget more opportunity and therefore it is worth giving strong consideration to the first option that comes your way.  

Health plans and other payers who are dedicating more time to engaging specialty pharmacies in value-based patient management opportunities are looking for partnerships. While dispensing activities have historically driven more transactional interactions between specialty payers and providers, the opportunities around VBC tend to favor more longitudinal, engagement-oriented partnerships. The first step in these relationships is demonstrating the ability to execute.  

As a final note on this point, it may be best to look at the early opportunities as investments. It’s unlikely that the first opportunity will be a game-changer in terms of singularly taking your specialty operation to the next level, but the accumulation of opportunities and partnerships with payers can do just that.  

Data exchange facilitates communication, and communication is the foundation of good relationships. 

Having a common language between a health plan and the specialty drug providers who take care of their members is essential for both sides to feel like they are getting a good deal out of a VBC opportunity. The health plan will want to understand engagement and the value of the program outcome. The specialty drug provider will need to be efficient and effective in their execution.  

A shared understanding of the expected value of the program will go a long way to encouraging engagement and understanding if the program is truly able to sustainably deliver value for both sides of the relationship. This is where having the right partners to deliver data tactically during clinical processes, organize efficient clinical workflows, and coordinate the program access and reporting are essential to success, and will allow specialty drug providers to take on and benefit from more opportunities. 

Pictured from left to right: Karen Silverblatt, Inovalon; Sarah Marche, Highmark; Mark Conklin, Free Market Health; and Olufunke Pickering, Inovalon.