Calling all health care stakeholders. Join us to hear a firsthand account of CMMI’s current initiatives, future program directions, and the role NQF is playing to ensure that performance measurement lives up to its potential to help organizations achieve the Quadruple Aim in the ever-changing, value-based landscape. Examples of where innovation is happening and lessons learned will be shared from both perspectives. Learn practical considerations that will help you spur the changes you need in multi-payer, value-based arrangements.
President and Chief Executive Officer
National Quality Forum
Senior Advisor and Medical Officer
Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services
Leading payer organizations lend insight into their goals for value-based contractual partnerships with providers and manufacturers.
- Explore how payers perceive value and the quality and outcome metrics they want to incentivize for reimbursement
- Hear examples of the successes and challenges faced as payers, providers, and manufacturers participate in more value-based contracts
Associate Vice President, Market/Industry Insights, Chief Medical Organization
Senior Medical Director, Value-based Care and Innovation
UPMC Health Plan
Population health leaders from leading organizations engage in a revealing discussion on the challenges and issues they confronted while designing and implementing successful APMs.
- Discuss favorable market conditions, partnership development, and collaboration strategies
- Learn why a health system or medical group chose these models, including:
- Medicare ACO
- Medicare Advantage
- Commercial shared-risk arrangements
- Bundled/Episode-based payments
- Direct-to-Employer contracting
- Hear about challenges faced and steps to mitigate issues during implementation
- Discuss what’s next for the evolution of chosen models
Medical Director, Quality and Payment
American Academy of Family Physicians
Vice President, Population Health Management
Duke University Health System
Vice President, Business Development & Performance Management
UNC Health Alliance
Vice President, Market Access
Value-based contracts (compared to traditional rebates and discounts) require highly complex negotiations on price, selection of outcomes, and the agreement on legal terms between all stakeholders in order for an agreement to be reached.
- Understand how to create a product value story to communicate your product’s effectiveness to the payer and provider communities
- Examine value based contracting terms, conditions, and metrics necessary to implement a successful value-based strategy
- Align the internal objectives of HEOR, Managed Markets, Market Access, and Accounts teams to achieve a streamlined approach to designing a value-based contract
Director, Value-Based Purchasing
UPMC Health Plan
Due to the high list prices for cell and gene therapies, payers are seeking more risk-based agreements and evidence around the long-term value of these products.
- Describe types of arrangements being agreed upon for cell and gene therapies, and components that could be applied to other types of agreements
- Explore where price reporting and other legal implications must be considered
- Identify common challenges faced in contract development due to the unique characteristics of these disease states
This summer, the Trump administration withdrew a proposed rule to exclude safe harbor protection for contracted rebates in Part D plans and Medicaid Managed Care Organizations. However, in some ways, the commercial sector has shifted to accommodate a world without rebates, and the debate around rebates and how drugs are negotiated and paid for is continuing to permeate federal and state policy discussions.
- Discuss how rebates flow between manufacturers, PBMs, payers, and patients
- Understand how policies around alternative rebate models will either support or impact value-based contracts and indication-specific pricing agreements
- Explore alternative options for rebate models, point of sale rebates for patients, and upfront discounts
Director of CER Policy Development
Institute for Clinical and Economic Review
Data will underpin the future value-based reimbursement model and is a critical component of value-based contracts. However, there are many barriers to accessing and analyzing the appropriate data to measure patient outcomes and metrics for these contracts. During this session we will:
- Explore emerging metrics that payers are looking for when contracting with manufacturers and their expectations of “value”
- Discuss approaches to accessing, analyzing and sharing the data necessary to support VBCs
- Explore opportunities to streamline the entire VBC process from contract design to operations to help make these agreements more mainstream
Deloitte Consulting LLP
Examine ways a RWE strategy can be used to provide product insights from clinical development through commercialization.
- Develop an end-to-end evidence management strategy to establish differentiation and a competitive advantage in the marketplace
- Align appropriate data sources and methodologies with RWE goals
- Collaborate with colleagues across the product lifecycle – from the pre-clinical stages onward - to enable effective deployment of your RWE strategy
Vice President, Global Head, Real-Word Evidence and Clinical Outcomes