The State of Healthcare: Why Getting Value Right Matters in 2016 and Beyond

Earlier this month, President Obama delivered the final State of the Union of his presidency.

While the President raised a number of important issues during his address, the State of the Union also serves as an opportunity for us to reflect on the current state of the political and policy conversation, and to look forward to how we can address related issues in the coming year.

For many of us across the health care system, that means contending with the very real challenge of how — in the midst of the growing concern about the cost of care and, specifically, the cost of innovative medicines — we can move toward a system that truly puts value and patient access at its center.

The good news? We are beginning to see progress.

In fact, over the last year, public and private payers, providers, and the pharmaceutical industry have taken important first steps in working together toward a system that rewards the value of care instead of the volume of care.

However, as we move ahead in 2016, the real work begins.

Because even as the Centers for Medicaid and Medicare (CMS) and others begin to incentivize the implementation of value-based systems — the very notion of how we define “value” remains under debate. And for good reason, because in order to ensure that we have a system that truly rewards good outcomes, improves meaningful patient access, supports evidence-based decision-making, and encourages innovation — we have to get the answer to “what is value?” right.

And getting it right must start with the patient’s voice.

The challenge? The very nature of our existing health care system is such that each stakeholder has often been left to examine this incredibly complex question around defining value in a vacuum.

That means for many academics — particularly those focused on making value measurable — value has frequently become a linear equation solved by looking at the ratio of health care outcomes achieved to dollars spent.

For payers, whose assessments are largely confined to one-year budget windows, the valuation of a therapy is often limited to the cost of that treatment alone, rather than as part of our entire health care system over time.

And for many patients — including those fighting chronic conditions such as hepatitis C — the value of a treatment “is almost incalculable.” As Donna Cryer, president and CEO of the Global Liver Institute, shared, it’s not only returning to life and work, having and taking care of children, but also “being acknowledged as a member of society worth saving.”

The list of ways health care stakeholders think about value goes on and on and, as a result, the gulf between what is perceived as “high” and “low” value has only continued to grow — with the voice of patients often lost in the middle.

Importantly, it’s not that aspects of each of these approaches to defining value don’t hold any merit. They do.

But the reality is that when a medicine’s value is assessed without transparency, under such a wide-range of criteria with varying weights and timelines, and without full consideration of all stakeholders and how that treatment contributes to our broader healthcare system — we lose the opportunity to meaningfully address the real issue: the full value of a biopharmaceutical treatment over a patient’s lifetime.

And when that happens, it’s not just patients that lose out, but our entire health system.

That’s why we all have a stake in making progress in 2016 and beyond to improve patient access to medicine and high-quality care, to better understand and share how treatments are working in the real-world, to push for new discoveries, and to define the full value of each therapy over a patient’s lifetime.

So as value assessment tools continue to emerge from academics, providers, payers, and patient organizations, we need to develop guiding principles that will ensure these assessments are effective and support meaningful value in patient care and outcomes, while being flexible and responsive to how patients experience care in the real world.

Over the next year, we stand ready to roll up our sleeves and continue the conversation with stakeholders across the country and — with the help of patients — get the answer to “what is value?” right.

Morning Consult