PIPC convened this roundtable because we are very concerned that payers, physicians and policymakers are increasingly using value frameworks in the private sector – and potentially in the public sector – to determine patient access. Many emerging value frameworks are driven by payers, represent the ideals of payers, and are therefore representative of their goal to reduce costs. Although labeled as “value frameworks,” many of these frameworks do not accurately capture what patients value. In fact, they often are in conflict with stakeholder efforts to move towards a more patient-centric health care system and advance access to personalized and precision medicine.
The shortcomings of status quo value frameworks and tools and potential considerations for improving their patient-centeredness were summarized as follows:
- Value Framework’s Focus on Cost Effectiveness Limits Their Use by Patients & Providers
- Value Frameworks Are Limited by Focus on Randomized Clinical Trials (RTC) Data
- Value Frameworks Lack Transparency
- Value Framework Developers Often Fail to Engage Patients and People with Disabilities
- Lack of Consensus on Assumptions, Definitions and Questions
- Fail to Reflect Outcomes that Matter to Patients and People with Disabilities
- Produces a Single Universal Score or Value
- Use of Quality Adjusted Life Years (QALYs) Disadvantages People with Disabilities
- Focus is on Cost to Society, Not Costs that Matter to Patients
To Impact the Status Quo Development of Value Frameworks and Tools, participants agreed to the following next steps:
- Advocate for Use of the National Health Council’s Patient-Centered Value Model Rubric
- Train Advocates to participate and comment on the development of value frameworks and tools.
- Engage Providers to ensure that value assessment frameworks do not conflict with making treatment decisions that are right for individual patients.
- Engage Payers and encourage them engage with patients and people with disabilities in a conversation about how value frameworks are developed and used.
- Engage Policymakers to discourage the endorsement and use of existing value frameworks and tools in public policy.
- Engage Purchasers who recognize the benefits of increased productivity and overall well-being, thereby increasing employee retention.
- Create Multiple “Disruptive” Alternative tools that Capture Value to Patients