Over 35% of surveyed health plans said they used more than 10 outcomes-based contracts (OBCs) in the plan year 2022.
The majority of payers used OBC for prescription drugs in 2022, according to a survey by Avalere.
The healthcare consulting firm surveyed 46 U.S.-based health plans from February 14 to February 20, 2023, to gauge their use and experience with OBCs during the 2022 plan year.
Answers revealed that 58% of plans had at least one OBC, while about 10% had two to five contracts, another 10% had five to 10 contracts, and over 35% had more than 10 contracts. Around 15% of respondents said they had no contracts, but are in negotiations for one or more now.
Usage was modestly higher than in 2021, when Avalere found that 56% of payers had an OBC. That year, 12% of plans reported having more than 10 OBCs, which was double the mark from 2020. With that number almost tripling in 2022, the trend shows payers are becoming more willing to utilize the value-based approach.
When asked why they are currently using OBCs, respondents said they were for new products mostly, as well as some existing products, "reflecting growing interest among stakeholders to align payment with clinical benefit, particularly for new products that have limited real-world clinical benefit."
The top three therapeutic areas in which payers utilized OBCs in 2022 were oncology, cardiology, and endocrinology.
Additionally, 74% of respondents with at least one OBC said they prefer contracts with both claims-based and clinical outcomes. Yet, 53% indicated they do not feel claims-based outcomes are a good proxy for clinical benefit.
"Claims-based measures are typically easier to track because they leverage information that plans and PBMs are already gathering, rather than clinical outcomes that may need to be tracked specifically for an OBC," the researchers wrote.
"Clinical measures can be more difficult to track if they require new data infrastructure and pose an additional administrative burden on providers and other stakeholders. Therefore, while clinical outcomes may better reflect clinical benefit, claims-based outcomes are more practical."
The survey notes that lack of consensus on which metrics of value are meaning measures of clinical benefit is one of the barriers to value-based care.
Jay Asser is the contributing editor for strategy at HealthLeaders.
KEY TAKEAWAYS
Avalere's survey of 46 payers revealed that 58% of plans used at least one OBC in 2022, with around 10% having two to five contracts, another 10% having five to 10 contracts, and over 35% having more than 10 contracts.
The percentage of payers with more than 10 contracts tripled the mark from last year's survey, indicating increased willingness by payers to utilize a value-based method.
Nearly a quarter of payers (74%) with at least one OBC in 2022 said they prefer contracts with both claims-based and clinical outcomes, with 53% noting they do not feel claims-based outcomes are a good indicator for clinical benefit.