John W. Draper, EVP, Healthcare Reform and Market Access, Sentrix Health Communications
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Healthcare reform is rapidly moving to value-based reimbursement, prompting institutions and providers to join together and create new organizations capable of coordinating the care necessary to achieve value-based outcomes.
These are the new pharma industry’s B2B customers:
organized groups of institutions and providers (health systems) focused on achieving the accountable care that healthcare reform demands.
It is now old news that the Affordable Care Act (ACA) initiated the conversion from volume- to value-based reimbursement in 2010. The goal of the Department of Health and Human Services’ (HHS) value-based payments plan was to achieve the “Triple Aim”:
1. Improve patient outcomes
2. Enhance patient experience
3. Reduce costs
HHS’s objective was to tie 30% of all Medicare payments to these value-based payments by the end of 2016.
Although there has been much discussion in the media regarding the progress of the ACA, the Center for Medicare & Medicaid Services (CMS) announced that the 30% value-based payment mark was achieved in January of this year — more than 11 months early.
This accomplishment is credited to the growth of organized customer groups — Accountable Care Organizations (ACOs),
Integrated Delivery Networks (IDNs), and health systems — focused on achieving value-based payments. The march to value is likely to continue, particularly because HHS aims to have 50% of payments linked to value by 2018.
Providing Value for the New Customer Base
Clearly, a lot of value-directed activity has been going on behind the scenes. Healthcare institutions, hospitals, and their extended physician networks have been rushing to meet quality-reporting requirements under Meaningful Use (MU), avoid readmission penalties, and implement value-based purchasing.
The impact of this shift to value-based reimbursement is that physicians and health systems are increasingly consolidating to enhance their ability to coordinate care for patients as they journey across different settings of care.
These recently consolidated health systems and groups of providers that help manage care across multiple settings are the pharma industry’s new organized customers. IDNs are among the fastest growing.
Historically, IDNs employed their size to drive purchasing and contracting economies, but now they are leveraging their networks’ control to drive better patient outcomes and create a value-based competitive advantage when contracting with payers.
The ACA also established ACOs and, although they got off to a slow start, there are now close to 1,000 of these groups connecting the dots through the delivery of quality coordinated care.
A New B2B Opportunity
New organized customers present pharma companies with an exciting B2B opportunity. In order to engage these customers, it is critical we develop market-based communication tools supporting the customer-centric value of our products. Organized customers need to thoroughly understand the burden of a disease and unmet need our products address. Each organized customer’s network of providers needs to understand the quality metrics relevant to each disease and how those metrics will be evaluated. Organized customers need to understand how appropriate use of pharmaceuticals can help achieve quality metrics and how they can accurately communicate their achievements to payers using EHR systems.
The life-sciences industry is moving into a new B2B value-based era. Agencies need to be equipped with the tools to help empower these newly organized customers to achieve the quality care that healthcare reform demands. (PV)
Sentrix Health Communications is a fully integrated agency supported by the WPP Global Network, that provides resources that are multichannel, multidiscipline, and multiaudience.
For more information, visit www.sentrixhealth.com.