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New reimbursement model for pharma 20DEC17

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For your consideration, a new reimbursement model for pharma that is sustainable and truly value-based.

Veröffentlicht in: Gesundheitswesen
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New reimbursement model for pharma 20DEC17

  1. 1. a new reimbursement model for pharma for your consideration: wayne pan, md phd mba wtp94015@gmail.com
  2. 2. we know that the healthcare reimbursement environment is changing
  3. 3. moving from fee for service to value-based model
  4. 4. do we want to be followers and wait for change to happen to us?
  5. 5. or do we want to be masters of our own destiny and lead the change?
  6. 6. think outside of the box
  7. 7. “You never change things by fighting existing reality. To change something, build a new model that makes the existing model obsolete” R. Buckminster Fuller
  8. 8. what’s our existing reality?
  9. 9. DRUG PRICE = R&D COSTS TARGET POPULATION ~
  10. 10. DRUG PRICE R&D EXPENSES = TARGET POPULATION ~
  11. 11. DRUG PRICE R&D EXPENSES = TARGET POPULATION ~ $ $$$$$ drugprice
  12. 12. DRUG PRICE R&D EXPENSES = TARGET POPULATION ~ $ $$$$$ drugprice population size
  13. 13. DRUG PRICE R&D EXPENSES = TARGET POPULATION ~ $ $$$$$ drugprice population sizetraditional model personalized healthcare
  14. 14. $ $$$$$ population size drugprice DRUG PRICE R&D EXPENSES = TARGET POPULATION ~ traditional model personalized healthcare *assuming constant R&D expenses
  15. 15. $ $$$$$ population size drugprice DRUG PRICE R&D EXPENSES = TARGET POPULATION ~ traditional model personalized healthcare max price market will bear *assuming constant R&D expenses
  16. 16. $ $$$$$ population size drugprice DRUG PRICE R&D EXPENSES = TARGET POPULATION ~ traditional model personalized healthcare max price market will bear *assuming constant R&D expenses
  17. 17. $ $$$$$ population size drugprice DRUG PRICE R&D EXPENSES = TARGET POPULATION ~ traditional model what about personalized healthcare? max price market will bear
  18. 18. $ $$$$$ population size drugprice DRUG PRICE R&D EXPENSES = TARGET POPULATION ~ traditional model personalized healthcare max price market will bear *assuming ability to reduce R&D expenses proportionally to reduction in target population
  19. 19. June 14, 2015 • by Liz Szabo
  20. 20. June 14, 2015 • by Liz Szabo October 31, 2016 • by Carolyn Y. Johnson
  21. 21. June 14, 2015 • by Liz Szabo October 31, 2016 • by Carolyn Y. Johnson A Look at Major Drug-Pricing Proposals by Katie Thomas May 29, 2017
  22. 22. March 15, 2016 by Kim Janssen June 14, 2015 • by Liz Szabo October 31, 2016 • by Carolyn Y. Johnson A Look at Major Drug-Pricing Proposals by Katie Thomas May 29, 2017
  23. 23. March 15, 2016 by Kim Janssen December 31, 2015 by Joseph Walker June 14, 2015 • by Liz Szabo October 31, 2016 • by Carolyn Y. Johnson A Look at Major Drug-Pricing Proposals by Katie Thomas May 29, 2017
  24. 24. EXISTING
 REALITY
  25. 25. EXISTING
 REALITY
  26. 26. EXISTING
 REALITY contracting rebates outcomes-based pricing
  27. 27. DOES THIS REALLY
 CHANGE OUR
 REALITY?
  28. 28. IF YOU DON’T HAVE A SEAT AT THE TABLE YOU’RE ON THE MENU
  29. 29. A SEAT AT THE TABLE? DO WE WANT
  30. 30. WE GET A SEAT? HOW MIGHT
  31. 31. CLUE:
  32. 32. LOOK AT WHERE THE HEALTHCARE SYSTEM IS GOING CLUE:
  33. 33. adapted from IHI Triple Aim improvepopulationhealth lowerpercapitacostofcare improve healthcare experience the triple aim
  34. 34. triple aimvalue =
  35. 35. VALUE BASED CARE
  36. 36. HOW COULD WE PARTICIPATE AS FULL PARTNERS IN VALUE-BASED CARE?
  37. 37. CONSIDER TAKING ON RISK
  38. 38. patients
  39. 39. purchaserspatients
  40. 40. payers purchaserspatients
  41. 41. providers payers purchaserspatients
  42. 42. providers payers purchaserspatients pharma
  43. 43. providers payers purchaserspatients pharma others
  44. 44. providers payers purchaserspatients pharma
  45. 45. providers payers purchasers patients pharma healthcare1.0
  46. 46. providers payers purchasers patients pharma healthcare1.0 RISK
  47. 47. providers payers purchaserspatients pharma healthcare2.0 RISK RISK
  48. 48. providers payers purchaserspatients pharma healthcare3.0 RISK RISK RISK
  49. 49. providers payers purchaserspatients pharma healthcare4.0 RISK RISK RISK? RISK
  50. 50. “You never change things by fighting existing reality. To change something, build a new model that makes the existing model obsolete” R. Buckminster Fuller
  51. 51. moving from targeting patients
  52. 52. to managing the total population
  53. 53. let’s look at the populationthat we would be managing
  54. 54. using a forest as a metaphor
  55. 55. lush forest using a forest as a metaphor
  56. 56. lush forest forest fire using a forest as a metaphor
  57. 57. lush forest forest fire burnt forest using a forest as a metaphor
  58. 58. wellness palliative care using a forest as a metaphor diseased state
  59. 59. this is where pharma resources are focused under FFS wellness palliative carediseased state
  60. 60. from a system perspective, we’re not allocating enough resources to wellness and palliative care wellness palliative carediseased state
  61. 61. from a system perspective, we’re not allocating enough resources to wellness and palliative care wellness palliative carediseased state
  62. 62. 4QUADRANTS
  63. 63. Higher Price Transparency Lower Price Transparency HIGH TECH LOW TECH http://www.expressbpd.com/pharma/it-at-pharma/digitizing-drug-development-how-much-can-it-save/384883/
  64. 64. Higher Price Transparency Lower Price Transparency HIGH TECH LOW TECH Status Quo • Price inflation continues at
 current pace • New innovative products enter
 the market at premium prices • Fewer R&D efficiencies from
 technology http://www.expressbpd.com/pharma/it-at-pharma/digitizing-drug-development-how-much-can-it-save/384883/
  65. 65. Higher Price Transparency Lower Price Transparency HIGH TECH LOW TECH Status Quo • Price inflation continues at
 current pace • New innovative products enter
 the market at premium prices • Fewer R&D efficiencies from
 technology http://www.expressbpd.com/pharma/it-at-pharma/digitizing-drug-development-how-much-can-it-save/384883/
  66. 66. Higher Price Transparency Lower Price Transparency HIGH TECH LOW TECH Status Quo Doomsday • Price inflation continues at
 current pace • New innovative products enter
 the market at premium prices • Fewer R&D efficiencies from
 technology • Public pressure and 
 government action forces put
 downward pressure on drug
 prices as the system moves to
 fee for value • Increased transparency into
 R&D costs • Margins contract http://www.expressbpd.com/pharma/it-at-pharma/digitizing-drug-development-how-much-can-it-save/384883/
  67. 67. Higher Price Transparency Lower Price Transparency HIGH TECH LOW TECH Rainbow’s End Status Quo Doomsday • Innovation continues to be
 rewarded with premium
 pricing • Core basket of drugs continues
 inflating at high double digits • Innovation in biology and 
 technology leads to R&D
 efficiencies and better drugs • Price inflation continues at
 current pace • New innovative products enter
 the market at premium prices • Fewer R&D efficiencies from
 technology • Public pressure and 
 government action forces put
 downward pressure on drug
 prices as the system moves to
 fee for value • Increased transparency into
 R&D costs • Margins contract http://www.expressbpd.com/pharma/it-at-pharma/digitizing-drug-development-how-much-can-it-save/384883/
  68. 68. Higher Price Transparency Lower Price Transparency HIGH TECH LOW TECH Rainbow’s End Status Quo Balancing Act Doomsday • Innovation continues to be
 rewarded with premium
 pricing • Core basket of drugs continues
 inflating at high double digits • Innovation in biology and 
 technology leads to R&D
 efficiencies and better drugs • Price inflation continues at
 current pace • New innovative products enter
 the market at premium prices • Fewer R&D efficiencies from
 technology • Public and government put
 downward pressure on drug
 prices and increases
 transparency for R&D costs • Innovation in biology & tech
 leads to better drugs & R&D
 efficiencies to offset pricing
 pressures • Public pressure and 
 government action forces put
 downward pressure on drug
 prices as the system moves to
 fee for value • Increased transparency into
 R&D costs • Margins contract http://www.expressbpd.com/pharma/it-at-pharma/digitizing-drug-development-how-much-can-it-save/384883/
  69. 69. Higher Price Transparency Lower Price Transparency HIGH TECH LOW TECH Rainbow’s End Status Quo Balancing Act Doomsday • Innovation continues to be
 rewarded with premium
 pricing • Core basket of drugs continues
 inflating at high double digits • Innovation in biology and 
 technology leads to R&D
 efficiencies and better drugs • Price inflation continues at
 current pace • New innovative products enter
 the market at premium prices • Fewer R&D efficiencies from
 technology • Public and government put
 downward pressure on drug
 prices and increases
 transparency for R&D costs • Innovation in biology & tech
 leads to better drugs & R&D
 efficiencies to offset pricing
 pressures • Public pressure and 
 government action forces put
 downward pressure on drug
 prices as the system moves to
 fee for value • Increased transparency into
 R&D costs • Margins contract ?http://www.expressbpd.com/pharma/it-at-pharma/digitizing-drug-development-how-much-can-it-save/384883/

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