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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.



Contributors

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 ‘next-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

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