June 2014

Outcomes-based measurement
Redening our approach to adherence
AN E P S I L ON P E R S P E C T I VE
HEALTHCARE
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Introduction 3
The importance of health outcomes 4
Outcomes-based measurement 5
Redening adherence programs 6
Epsilon recommendations 6
Conclusion 7
Contents
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And in most cases, we measure the success
of our promotional spending and these
programs in terms of their ability to ensure
that patients continue to ll scriptswhich
we take as a proxy for adherence to therapy.
As a pharmaceutical industry, we
collectively spend billions of dollars
promoting therapies to patients to
stimulate interest, intent, and ongoing
product use. We run television ads.
We launch branded and disease-
awareness websites. We create
complex, multichannel relationship
marketing programs.
Introduction
But in todays changing healthcare
environment, it is becoming increasingly
important for us to take a broader, more
patient-centric view of successone
based on our ability to provide better
patient care, lower costs, and improve
patient outcomes.
16
%
37
%
of health insurers have adopted
new payment and contracting
arrangements such as outcomes-
based payments, risk-sharing
agreements and bundled payments
with pharmaceutical companies.
of those who havent adopted
new payment and contracting
arrangements are expected
to adopt them within the
next three years.
PwC Health Research Institute
(HRI), 2012
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The importance of health outcomes
Healthcare outcomes are broadly dened as
changes in a patients health status that can
be attributed to the care he or she received.
Achieving positive patient outcomes is the
fundamental purpose of healthcare.
Traditionally, outcomes-based initiatives
have been the focus of provider networks,
which today are being driven by policy
and payers alike toward performance-
measurement systems. New players such
as Accountable Care Organizations (ACOs)
are offering increasing incentives to provide
quality care and better outcomesand
disincentives for failing to. Proponents
argue that these systems discourage
unnecessary treatments, keep people
healthier, and reduce overall costs.
The pace of change in the healthcare market
is accelerating, and there is growing pressure
on all stakeholdershealthcare systems,
payers, policymakers, prescribers, and
pharmaceutical companies to focus on
value-based health outcomes.
While sales and volume will continue to
be key nancial success metrics for in-line
pharma marketers, outcomes will rapidly
become the yardstick for how the industry
as a whole is performing in improving
patient health. Health outcomes will also
increasingly drive formulary access, pricing,
and reimbursement decisions.
The ability to prove to patients that they are
more than a script, to demonstrate positive
patient impact to healthcare providers, and
to show payers that a brands value extends
beyond the clinical benets of the drug will
be the keys to success for pharma marketers
in this outcomes-based world.
McKinsey, 2013
Outcomes-based payment can reduce known
sources of waste and inefciency (redundant
care, misuse, etc.), resulting in 10% or greater
decrease in targeted spending.
Merck agreed to peg what the insurer Cigna pays for the diabetes
drugs Januvia and Janumet to how well Type 2 diabetes patients
are able to control their blood glucose. In return, Merck got better
placement for Januvia and Janumet on Cignas formulary.
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Outcomes-based measurement
Moving toward an outcomes-based
approach requires that pharma take a
different view of measurement. Companies
must dene the key outcomes against
which they will measure success; identify
practical and reliable methods to aid
comparisons; and develop routine reports
to showcase results. And for drugs in
development, they will need to identify
the relevant measures early enough
to incorporate them in Phase III/IIIb
trial designs.
Primary outcomes measures may include
total healthcare costs, incidence/prevalence
of particular disease states, rates of specied
diagnostic/therapeutic procedures,
hospitalization rates, and productivity and
quality of life measures. These may be
determined based on the type of condition
(e.g., chronic vs. acute) and the intent of
the program (e.g., primary vs. secondary
prevention vs. general wellness). Core data
for these measures will need to be derived
from a combination of proprietary and
third-party sources including self-reported
patient surveys, medical claims, and
prescription sources.
The level of rigor applied to program
evaluation should balance feasibility and
cost. A randomized control trialgold-
standard for clinical researchis not always
possible. At a minimum, we must ensure
that we are collecting patient-level
information and measuring against a
comparison group or baseline measure.
We must also consider the duration of
measurementtypically in 12-month
incrementsand plan accordingly.
MEDICAL CLAIMS
QUALITY OF LIFE
PATIENT SURVEYS
PRESCRIPTION SOURCES
HEALTHCARE COSTS
DISEASE-STATE INCIDENCE
DISEASE-STATE
PREVALENCE
DIAGNOSTIC
PROCEDURE RATES
THERAPEUTIC
PROCEDURE RATES
HOSPITALIZATION RATES
HOSPITALIZATION
PRODUCTIVITY
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Redening adherence programs
So how do we move toward an outcomes-
based approach? We start by asking some
simple questions:
Are our programs truly designed to
improve a patients health?
Are we helping patients understand
the risk factors associated with their
conditions?
Are we providing targeted interventions
designed to stimulate positive health
behavior?
Does participation in our program result
in better health, lower health costs, and
increased productivity and quality of life?
If we cant answer those questions with a
resounding, Yes! then we have some work
to do. The challenge is not insurmountable,
but it does require a shift in perspective
and a new toolset.
In 2011, Cigna initiated a partnership with EMD Serono designed
to reduce relapses in MS patientsadverse events that cost the
health plan up to $11,000 per hospitalization. Cigna/EMD are
tracking the percentage of hospitalization and emergency room
visits avoided by people using Rebif to convincingly demonstrate
that any increased drug spend is offset by improved clinical
outcomes and decreased costs-to-treat.
Develop a health assessment
strategy. Allow patients to better
understand their current health status and
to identify potential near- and long-term
health risks.
Create a risk stratication plan.
Group patients into meaningful risk-based
categories that allow the program to target
relevant, timely, and actionable content,
tools and resources.
Design segment-specic
health management intervention tools.
Help patients understand, navigate, manage,
and coordinate the healthcare resources
available to them, and enable them to
become proactive and engaged managers
of their own health.
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2
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Planning for any outcomes-focused program should incorporate
three critical pillars:
Epsilon recommendations
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Conclusion
A mounting body of evidence demonstrates
that patients who are actively engaged in
their own healthcare will experience better
outcomes and incur lower costs.
Active engagement incorporates two key
concepts:
The patients willingness and ability to
manage his or her own health and care,
and
The empowerment of that willingness
and ability with targeted interventions
designed to promote positive patient
behavior.
If we can make the shift to thinking about
adherence programs as tools to enable
the good of patientsnot just to secure
additional rellswe will be able not only
to measure our success in improved health
outcomes, but to meet the new challenges
of our changing healthcare system.
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By Bruce Grant, SVP/Strategy, Epsilon Healthcare
A veteran with more than four decades in healthcare marketing and digital business strategy, Bruce
currently serves as Senior Vice President of Strategy for Epsilons Healthcare Portfolio. In this capacity,
Bruce offers evidence-based strategic counsel to Epsilon clients, internal teams, and partner companies,
as well as development of new offerings to meet the changing needs of healthcare marketers.
Ad Age as the #1 U.S. Agency from All
Disciplines, #1 World Largest CRM/Direct
Marketing Network and #3 Largest U.S.
Digital-Agency Network, we employ over
5,000 associates in 60 ofces worldwide.
Epsilon is an Alliance Data company. For
more information, visit www.epsilon.com,
follow us on Twitter@EpsilonMktg or call
800.309.0505.
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