Kimberly Westrich Discusses the Future of Value Assessment Tool Use in the US

Kimberly Westrich, MA, chief strategic officer at the National Pharmaceutical Council (NPC), discussed the future of value assessment tools in the US health care system. In her role, she provides strategic guidance to NPC’s policy research and communications activities, leads several research initiatives across NPC’s portfolio, and mentors NPC researchers and fellows.

Transcript

How do you envision the future of value assessment tools in the US health care system? What trends do you expect to shape the field in coming years?

This brings to mind an interesting conversation that's been happening for a few years. I don't think it's going to be settled soon, but there's been ongoing conversations about whether or not we need a national value assessment, or health technology assessment, body here in the United States. Outside of the United States, there are many countries that have a single health technology assessment body, and that makes sense because, outside of the United States, there's often centralized health insurance provided by the government; of course, here in the United States, we've got a decentralized system.

That said, there are many people who think that it would still be useful to have a centralized health technology assessment body, and there's been recent conversations looking at CMS and some of the things that CMS is doing related to, for example, coverage with evidence development for Alzheimer's disease, or getting involved in Medicare drug price negotiation. There are people who think, "Well, CMS is already starting to do some things that seem to be consistent with value assessment, and should CMS be a value assessment body?" There's people on both sides of the issue, some people think that CMS should be leaning into that, some people say, "This is not a direction for CMS, it would be biting off more than it can chew, and if we did have a health assessment body here in the United States, it shouldn't be CMS."

We [Cencora] actually added some questions to our Managed Care Network survey this year to see if payers in the United States have an appetite for a national health assessment body, and, if so, what they might want that body to do. Surprisingly, 85% of payers were interested in having a national value assessment body. There was sort of a split between whether they wanted it to be government funded, that was about 50% of payers. Then, 40% were interested in a split between government and private funding so that you had funding coming from multiple sources; it wasn't beholden to just one part of the economy.

The interesting data was when we asked about what this value assessment body might do, 85% of the respondents were interested in having a value assessment body that looked at best practices and standards, really understanding, what does good value assessment look like? Seven out of 10 (this was a multiple response question) were interested in having a national HTA [health technology assessment] body that looked at quality value assessment reports that were conducted by others. For example, if ICER [the Institute for Clinical and Economic Review] does a value assessment report, this national assessment body could look at it and say whether or not it was of good quality. So, that was something that was very interesting to payers, as well. Then, a lower percentage, but still noteworthy, I think, closer to 6 in 10 were interested in a national assessment body that did conduct its own value assessment. So, there's most interest in what does good look like? Is this report an example of good? Then, still interest, but lesser interest, in conducting value assessments.

Still, when you step back and you look at all of that together, here, I think there is interest in getting more value assessment information by US payers, I don't think there's interest in prescriptive value assessment information, or something that says, "This is how this should be used." Here in the United States, we're always interested in having more information, more is better, but we don't want someone to tell us exactly how to use that information in a prescriptive way.

This transcript has been lightly edited for clarity.