Accountable Care Organizations are set to transform the US health market, establishing efficiencies in patient care and physician working. While their impact to date is limited, ACOs ever widening remit as key funding and decision-making stakeholders makes them important players in the state and privately funded health market. Are ACOs friends or foes of pharma and how should the industry expand and adapt its stakeholder engagement strategies for best advantage?
Essential ACO Engagement: Mapping New Networks of Influence is essential reading for commercial planners and practitioners. The report is based on the insights and experiences of sales and market access professionals working in US pharma companies and experts working in ACOs see who they are. Packed with insights and actionable information, this study identifies the issues, threats and opportunity areas that ACOs present to the pharma industry.
“If pharma doesn’t work with the ACOs and show their product is of value, they won't prescribe it. The physician is at risk now, so companies have to demonstrate value for their product.”
Answering key questions
ACO Structure: There are 6 types of ACO – what are they, how do they differ from each other and why is it important to know? ACO Challenges: What are the challenges ACOs face and what role might industry play in overcoming them? Next Generation ACOs: How do the “next generation” ACOs differ from the pioneer ACOs and what should industry know about them? Data exchange? Industry can support its value proposition with real world data, while ACOs’ access to electronic medical records brings a wider perspective – could data be a platform for partnership? Drivers for change: What are the ACO drivers and priorities that could impact pharma sales? Drug Pricing: How might ACO value for money considerations impact drug prices? Engagement: In future, industry will have to engage with a wider group of stakeholders – what are the implications for resourcing and the structure of sales and market access teams?
With this report you will be able to
Learn the impact ACOs are currently having and know how “next generation” ACOs will differ Understand the patient care and cost saving drivers and priorities that are shaping ACO activity Know how and why ACOs will eventually influence prescribing and formulary decisions and develop value-based propositions that meet ACO and patient needs Identify the areas of mutual interest and collaboration between ACO and industry and formulate strategies for engagement Use the insights to review your current sales and market access resources and plan for wider stakeholder engagement in the future
Key topics explored
With an agenda for improving patient outcomes while reducing cost, ACOs are now part of the health landscape and will grow in importance. ACO organization varies widely and reflects the patient population needs it serves – this is a challenge for industry in establishing engagement and communication policies. Industry has been slow to accommodate ACOs in their stakeholder strategies, but as ACOs become more influential pharma must ensure the appropriate resource to engage effectively. Long-term relationships with KOLs may become less valuable as decision making moves to ACO teams and committees. Patient awareness of ACOs is low and the model of integrated care alien to US society: what communication issues does this raise for industry.
Jeff Carbone, VP, The Bloc Value Builders Les Duncan, Vice President of Accountable Care Initiatives, River Health ACO Jeb Dunkelberger, Executive Director, Accountable Care Services Lloyd J. Guthrie, MBA, Program Manager, Statewide Initiatives, Center for Improving Value in Health Care Managed Care Medical Director Market Access Director, midsize pharmaceutical company Senior director, global pharmaceutical company VP Managed Care
What is an Accountable Care Organization? Essentially, an ACO is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients and so limit unnecessary spending. ACOs are characterized by a payment and care delivery model that ties reimbursement for providers to quality metrics and reductions in the total cost of care for a particular population of patients. In essence, providers will receive payment if they are able to deliver outcomes that are shown to reduce overall spending on patient health – and that includes making cost effective medicines choices.
Table Of Contents
Essential ACO Engagement: Mapping New Networks of Influence 1Executive summary 2Research objectives and methodology 3Contributors 4Accountable care organisation overview 41Key Insights 411ACOs were established through the Affordable Care Act 412There are a number of requirements to participate in an ACO 4121ACOs can be made up of any type of healthcare provider 413The payment structure for ACOs heralds a move away from traditional fee-for-service 414The impact of ACOs has been limited to date 42The structure of ACOs varies across organisations 5ACOs and their impact on the US healthcare environment 51Several benefits of ACOs 52Key Insights 53There are significant cost savings that could be realised 54Providers are incentivised to provide quality not quantity of care 55A key benefit of ACOs is the continuity of care they provide 56Improved access and a reduction in administration is anticipated 57There are a number of challenges with ACOs 58There is significant initial investment needed to form an ACO 59Technology is a key challenge for ACOs 510Conflicting interests of different providers can defeat the purpose of an ACO 511There is still a lack of patient understanding about ACOs 512ACOs are driving changes in decision making 513ACOs are making decisions around reimbursement and listing 514Technology is having a greater impact on decision making 516Patient satisfaction is a key driver for ACOs 6Implications for the pharmaceutical industry 61Key Insights 62There are several key reasons why pharma should engage with ACOs 63Drug costs are likely to be a target for cost savings 64Drugs that have demonstrated value are likely to be favored by ACOs 65ACOs are expected to implement guidelines and lists to govern product use 66Pharma companies face significant risks if they do not engage with ACOs 67Pharma faces several challenges in engaging with ACOs 68The complexity of the ACO system means many companies have not yet adapted to it 69There is limited consistency between different ACOs 610Access to physicians in ACOs can be challenging 611Pharma is starting to collaborate with ACOs 612Teams interacting with ACOs 613Outcome data key to be a valuable partner 614Data exchange is a key area of focus 7 The future for ACOs 71Key Insights 72The ânext-generation' ACO model is being rolled out 73There is a greater level of risk and reward for the next-generation model 74Flexible payment options are being introduced 741Patient engagement has been made easier in the next-generation model 742ACO benchmarks have been improved 743There will be a transition from fee-for-service to value-based care 744Greater interaction with pharma is expected Products must provide value for the specific ACO population Real-world data is highly valued by ACOs Working as a genuine partner is the optimal way to interact with ACOs