Linking Payment to Health Outcomes
Over the past decade, there has been growing enthusiasm in many countries for linking access to new medical products with a requirement for collection of additional evidence on “real world” and comparative benefits and risk.
In the United States, the approach has been called “coverage with evidence development”, in the UK it is “only in research” and “risk-sharing”, and more recently the terms “access with evidence development” and “managed entry” have been more widely used. It is our hope that this new website will provide a forum for information sharing, dialogue and conceptual development for all of these initiatives that share the common objective of balanced access to new technology with the desire to have better information on how well they work.
To begin this conversation, we are posting an article by Dr. Carlson and his colleagues that was recently published in Health Policy, which provides a taxonomy of performance-based health outcomes reimbursement schemes. The paper defines this term as “…schemes between healthcare payers and medical product manufacturers in which the price, level, or nature of reimbursement are tied to future measures of clinical or intermediate endpoints ultimately related to patient quality or quantity of life”.
A systematic review was conducted to “…identify, categorize, and evaluate performance-based health outcomes reimbursement schemes between medical product manufacturers and payers…”, which identified 34 examples of coverage with evidence development, 10 examples of conditional treatment continuation, and 14 examples of performance-linked reimbursement.
We invite you to comment on Carlson et al.’s taxonomy of performance-based reimbursement schemes. Please feel free to cite other related papers and reports, work in progress, etc. In addition, feel free to raise any other topics in this broad field that you believe would be of interest to the other members of this group.
The article may be accessed through the link below.