Dr Steven Peskin on Reforms Needed to Incentivize Value-Based Contracts

Some policy reforms can help incentivize more use of value-based contracts, but overall an area that needs more work is value-based contracts with pharmaceutical companies, said Steven Peskin, MD, executive director, director of population health, Horizon Blue Cross Blue Shield of New Jersey.

Transcript

What policy reforms are needed in order to successfully incentivize the use of value-based contracts?

There are policy reforms related to that recognition that self-referral and the so-called Stark amendment may not be in the best interest of or it has a negative impact on value-based arrangements. So, that that would certainly be one.

I would say another would be that with commercial payers oftentimes, at least to some extent taking some license or following or acknowledging the important role of the Centers for Medicare and Medicaid Services and Center for Medicare and Medicaid Innovation. So, the OCM [Oncology Care Model] as well intentioned as it was didn't end up working very well. And it just doesn't apply to cancer care other areas, as well. So that kind of thought leadership and framing at the federal level that allows some of the private payers, commercial payers like ours to work within a particular policy framework. So, there's a couple of things that come to mind,

How have value-based contracts with pharmaceutical companies progressed?

The number of value-based contracts that exist between pharmaceutical/life sciences companies, biopharmaceuticals, cell therapy, gene therapy, is really few and far between. And it really is an area that needs to evolve. It’s something that is sort of a societal expectation, the way in which we as a nation approach health care and percentage of the gross domestic product. So, it’s definitely a work in progress and it needs a lot of work.