Can Value Frameworks Effect Real Change in Health Care?

The concept of value in health care has become increasingly important, and this is unlikely to change any time soon. Health care reforms have been proposed in order to slow the increase in health care costs while maintaining care quality, but patients, physicians, and payers alike continue to struggle with ever growing prices for specialty medications. For medical conditions in which these medications form the basis of treatment, such as cancer, controlling drug costs becomes a central issue in the effort to keep health care costs under control.

The concept of value has become important to the conversation surrounding appropriate drug pricing and reimbursement. However, stakeholders have yet to come to a consensus on how to define value. A number of associations and organizations have proposed various frameworks for assessing the value of different treatments. In this month’s installment of Pharma Insights, Jeremy Schafer, PharmD, MBA, et al look at value tools that are now available and discuss how they are being used by payers to assign value to different treatment options, particularly in the area of oncology (page 27).

While the introduction of value frameworks has so far moved the conversation surrounding value forward, whether value frameworks also have the potential to affect treatment decisions as well as medication pricing and reimbursement is unknown. Joshua Cohen, PhD, addresses the question of whether frameworks to assess the value of cancer drugs are likely to have an impact on pricing and reimbursement, in terms of both aligning the prices of cancer drugs with their value and improving patient access to high-value treatments (page 29). Looking towards other methods of increasing value, the proposed changes to the Medicare Part B program are discussed as likely having a greater immediate impact on pricing and reimbursement.

Finally, Goerge A Gellert, MD, MPH, MPA, and colleagues address the role of electronic health records adoption in the implementation of value-based care models (page 35). The authors assert that Meaningful Use requirements have played an important role in facilitating the advancement of data technology to support value-based reimbursement programs.