Value Assessments From Patient and Provider Perspectives

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The cost of some cancer drugs and lack of healthcare access are shocking to some patients. Fortunately, a tool called value assessments are now being utilized to gather and analyze various aspects of healthcare. Some possibilities for improvements could include things like lower drug costs, more effective cancer treatments, and improved healthcare access. To advance positive change, value assessments must include patient and provider perspectives in their analysis process.

Jennifer Bright, Chief Executive Officer of the Innovation and Value Initiative, stated about the importance of the patient perspective, “…the cost of healthcare, drugs or otherwise, is seldom based on its actual value. But while payers understand value largely in the context of utilization, efficacy, and cost, we still lack the ability (and the will) to understand and account for value from the perspective of patients, especially those living with chronic diseases.”

Value assessments are being used by healthcare policymakers to gather information to drive collaborative research and partnerships toward positive changes. It’s important to gather information from patients and healthcare providers to ensure that different perspectives are captured for analysis.

Value assessments analyze a variety of factors, some of which include:

  • Patient and provider preferences
  • Novel methods of value
  • Value assessment model development

Since healthcare methods are developing rapidly, it’s vital for value assessments to be carried out for tests, treatments, vaccines, and non-medical care.

Value Assessments for Treatments

The factors that are evaluated in clinical trials and the number of factors are key to the success of drug treatments that become approved from clinical trials. Clinical trial designs that fall short in accounting for enough potential patient situations will set themselves up to fail certain patients. For example, if a clinical trial evaluates treatment response in newly diagnosed cancer patients but fails to examine response for patients in whom other treatments have failed, the clinical trial has a failure in the data for those patients who haven’t responded to other treatments.

Or another value assessment scenario could look only at the factors of cost and performance compared to other drugs. If value assessments fail to examine other factors like patient age, patient medical conditions (comorbidities), and method of treatment delivery; then the drug could end up as a relative failure compared to its projected performance before its full release to patients.

Value Assessments for Healthcare Access

Healthcare access is another area of value assessment that can benefit from patient and provider perspectives. By taking action on patient requests, healthcare providers can reach more patients and diagnose patient conditions sooner compared to patients who were previously going unserved or underrepresented. Some examples of improved healthcare access in response to patient needs include:

  • Telemedicine as an option for healthcare appointments
  • Remote monitoring to decrease risk of viral infections
  • Healthcare providers talking to patients in community spaces like barbershops and churches to raise awareness about cancer screening

 Looking at the other side, some healthcare access has been hindered by failing to consider the impact to some patient populations including:

  • Older patients or patients in need of improving their technology literacy
  • Patients lacking access to high bandwidth Internet service
  • Patients without access to technology devices
  • Patients lacking English language proficiency

Value Assessments for Healthcare Technology

Healthcare technology has been growing by leaps and bounds as technology innovation continues. Patients and providers have both benefited from technology innovations such as:

  • Patient portals to refill prescriptions, send test results, and schedule healthcare appointments
  • Remote monitoring tools for checking patient heart function, lung function, activity levels, and brain activity
  • Using technology to replace tedious manual tasks to free up more time to spend with patients and to learn about new treatments
  • Translation services that provide printouts in foreign languages

Of course, as with most things, not all technology innovations are positive experiences. Some technology upgrades are rolled out by technology companies that fail to gather healthcare provider feedback during technology testing phases. And some of these technologies then cause more stress to providers. This undue stress can then result in both less time and lower quality time spent with patients who providers are trying to serve.

Value assessments are a vital tool to improve patient and provider experiences in healthcare. As healthcare policymakers drive collaborative efforts toward positive change, more patient and healthcare provider perspectives can be included to the benefit of both groups. The future could make possibilities like more affordable, effective drugs, improved healthcare access for all patient groups, and more focused appointments with healthcare providers a reality. But to reach these goals, value assessments must continue to incorporate diverse perspectives on healthcare from patients and healthcare providers.

 See More from the Health Policy Activity Guide

Sources

https://www.thevalueinitiative.org

https://www.healtheconomics.com/industry-news/innovation-and-value-initiatives-ivi-jennifer-bright-on-value-assessment-and-transparency

https://www.ajmc.com/view/how-to-make-value-assessment-more-relevant-to-healthcare-decisions

What Role Does Health Policy Play in Value Assessment?

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What Role Does Health Policy Play in Value Assessment? from Patient Empowerment Network on Vimeo.

 Jennifer Bright, CEO of Innovation and Value Initiative explains what role health policy plays in value assessment and health technology.

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Transcript

Mary Leer:

What role does health policy play in value assessment/health technology assessment? 

Jennifer Bright:

Policy has a really important role to play, especially at this time here in the US, as I pointed out earlier in our discussion, that there is a debate about best methods and what data and information we really need at our fingertips in order to make good decisions. And that’s not just at the health plan level or at the employer level, it’s also at the policy level, and so IVI does a lot of work in communicating about the work we do in the changing health economic modeling and doing different evaluations about patient preferences and how they have an impact on value assessment. We’re trying to communicate to the policy maker community writ large, why, because their decision-making about what the rules of road are in determining value here in the US is a really important missing voice. So, for example, we have a lot of CMS, we have employers, we have a lot of health plans that are coming out and talking about the importance of health equity. It’s a big topic and it’s an appropriate topic for us to be talking about. In our view at IVI, health equity is potentially could be worsened if we do not approach value assessment and health technology assessment with the patient perspective in mind, why? 

Because if we already have clinical data that is missing representativeness, and if we already have used economic evaluation methods that kind of eliminate the perspective of patients and families and their real experience in care, we are really at risk of hard-coding disparities in decision making in what you have access to as a patient, and that’s a very dangerous thing. And so that reason of that topic area of health equity is probably one of the biggest reasons why policy makers need to be understanding this landscape and the challenges from a scientific standpoint, and what the gaps are, and policy makers have a huge role to play, especially in championing the importance of having patient perspective represented in clinical trials represented in the line of value assessment, in having ability to calculate the cost on not just the patient, but the family and the caregiver. What’s the impact on their ability to work? All of those things are very complex, but they are all part of that value picture, and right now, there’s a bit of the tug of war in the health economics community about who’s got the best method, and we have a community that’s very used to doing value assessment the way they’ve always done it. 

And we believe at IVI that policy makers have a really important role in being a lever for change and kind of advocating for, pushing scientists to use different methods, but most importantly, to make sure that patient, family and caregiver voices are always at the table.

How Does Telemedicine Add to the Value of Care for Patients?

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How Does Telemedicine Add to the Value of Care for Patients? from Patient Empowerment Network on Vimeo.

Jennifer Bright, CEO of Innovation and Value Initiative explains how telehealth technologies and digital wearables can add to the value of care for patients.   

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Transcript

Mary Leer:

How are current trends such as telemedicine and our data wearables adding value to the overall care of patients? 

Jennifer Bright:  

Well, it’s such an interesting conversation. We at IVI, we do a lot of work in this space, thinking about incorporating new sources of data, so for example, we’re working on a major depressive disorder now, and as you know, there’s this burgeoning realm of telehealth and wearables and apps used in the behavioral health field. And so the reason that’s top of mind to me is that one of the challenges of… There’s these new technologies coming to market that allow us to bring care closer to the individual patients, which is exciting, but there’s two problems, one is we don’t have good ways of incorporating data from those types of interventions, wearables in other ways, we don’t have a good pathway to pull that data into value assessment, to really understand how does, how do these digital therapies and digital ways of delivering care make a difference to patient outcomes? So that’s one problem. And the other problem is there’s so much churn going on in wearables and apps and things like that, we don’t have a good handle on what are the metrics that we’re looking for that will tell us which thing has the most impact on the outcome. 

 So, a wearable is great for monitoring, you know it can monitor heart rate, monitor even A1C levels and things like that, can remind an oncology patient maybe to take a medication or to provide symptom monitoring back to their oncologist if that’s… They’re on chemotherapy or something, so there’s all these exciting ways of using that technology, but we lack a set of criteria in which we understand how does that benefit the patient, and how does that benefit the clinical outcome, and that to me, is going to create another bubble of fighting about value further down the road. Because if we don’t agree up front what’s the value to the patient and to their outcome, their life outcome, we’re not going to be able to measure it actively, and so then when we have this field of 100 different apps all of which are seeking to get bandwidth and money to be used, we don’t have a good way, we don’t have a good understanding of how to talk about the value of one versus the other.

Patient or Caregiver: What is My Role in Value Assessment?

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Patient or Caregiver: What is My role in Value Assessment? from Patient Empowerment Network on Vimeo.

As a patient, caregiver or an advocate, how can you play a role in value assessment? Jennifer Bright, CEO of Innovation and Value shares how we can improve the space of value assessment.

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Transcript

Mary Leer:

What is the role of the patient, the caregiver or the family in value assessment, and how can they improve it? 

Jennifer Bright:  

That is one of my favorite questions. One of the biggest parts that I feel needs to be improved in the space of value assessment, health technology assessment is the de facto involvement and presence of patient, family and caregiver perspectives. So I referenced the fact that in its simplest form, value assessment is really about understanding the clinical benefit of an intervention versus its cost, but as we know, clinical research, even today, does not capture so many of the things that patients and families and caregivers may deal with on a daily basis. It may not be representative of under-represented populations, it may not be representative of gender, how often do we hear that women are not well-represented in clinical trials, for example. So, because the clinical trial data may not represent fully represent a real population of individuals who are dealing with a certain type of cancer, for example, it automatically assess that whether the analysis of benefit versus cost is really reflective of the patient population for whom that decision is going to have an impact on what choice they have in treatment. Same goes for things like impact on family and caregivers. When we talk about cost, often when we talk about patient costs, the assumption is that we’re only talking about out-of-pocket, so co-payments or co-insurance. 

But what we know, especially in the realm of cancer treatment, there are myriad financial impacts that are not captured in clinical research, that are not captured in any kind of research, but that have absolutely have germaneness to decision-making to the ability to access care and to the outcomes, because you can have the best drug in the world, but if someone can’t get to it, if it’s an infusion therapy that’s covered by their health plan, but they can’t get to the infusion center on a consistent basis, then we are spending money on things that don’t match up with patient family, real experience. And so that’s a big gap in this area is that we don’t have a good mechanism for measuring aspects of care that are really important to patients and families, and then incorporating that into our economic analysis, so that’s a gap. And the way we need to improve it is in two ways, one is on the side of the researchers and the decision make our community, they are obligated and need to do a much better job of bringing patient and family and caregiver perspectives to the table at the front end of doing value assessment and health technology assessment. In other words, ask what’s important, what are the questions, what are the treatment options, what are the trade-offs those communities are dealing with in real time, and how do we measure the value to those needs? And then when we think about how can patients and families and caregivers improve like what’s the active role of the patient community, it’s being educated about this field, driving and asking for their participation, making sure that patients and families understand is the data that’s represented in this value assessment that says, this drug is better than this drug from a cost-effectiveness standpoint, ask the question, Does this reflect my experience? Does this reflect my community? Does this research look like me and my experience in care? And if the answer is no, speak loudly and to be under place at the table, and I think that that’s an advocacy at its core, but I think that change will come when both things happen, it can’t be an either or, there has to be changed from the research pipeline and the decision-maker side, and there has to be kind of that grassroots stand up and say, This is not a good decision because it doesn’t reflect real experience.

How Does Value Assessment Impact Patients?

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How Does Value Assessment Impact Patients? from Patient Empowerment Network on Vimeo.

Jennifer Bright, CEO of Innovation and Value Initiative breaks down how value and health technology assessment can impact patients and their families.

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Transcript

Mary Leer:

How is value assessment/health technology assessment used and how does it impact patients? 

Jennifer Bright:  

Well, I think there’s two levels to that answer internationally, health technology assessment has been on the radar for many years, most European countries and other countries use processes of health technology assessments to make decisions about how they allocate their resources. What’s unique is in most other countries, they’re dealing with a very different healthcare system than we are here in the US, and so what we have in the United States is a very fragmented system, and by that I mean we don’t have one single payer, we have many payers, we have people who are paying their own out of pocket, we have Medicare, we have Medicaid, we have commercial insurers, we have self-insurers, and each one of those decision-maker actors have different decision points, different patient populations that they covered lives that they’re responsible for, so each of those entities are trying to make decisions about allocation of their resources for their covered life population. And so, what we end up with, there’s lots of different methods, lots of different philosophies about how to way benefits and costs, and lack of consensus, and I think that’s probably the biggest comment I would make is here in the US, we don’t have one way of doing this, we don’t have agreement on the best way to assess existing technologies, we don’t have an agreement about the best way to assess emerging technologies, whether that’s a drug or a device or other kind of intervention. 

 And so that means there’s a lot of discussion and a lot of debates and a lot of research that’s coming out that may be confusing to particularly to patient populations, So, they look at all of this data and economic analysis and they’re left wondering, what does this mean for my treatments, what does this mean for my decision with my doctor? And I think that’s one of the advantages of the patient engagement network is to be able to… Patient Empowerment Network, to be able to educate patient communities about What is this process and does it represent the things that are important to me in my community on my journey with whatever cancer diagnosis that they’re dealing with.

What Is Value Assessment’s Role in Oncology?

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What Is Value Assessment’s Role in Oncology? from Patient Empowerment Network on Vimeo.

Jennifer Bright, CEO of Innovation and Value Initiative discusses the role value assessment plays in oncology and explains how it can help get the best patient outcomes possible. 

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Transcript

Mary Leer:

What is value assessment/health technology assessments’ role in oncology? 

Jennifer Bright:  

Well, you know there’s a lot of evolution in the diagnosis and treatment of different cancers, whether it’s breast cancer or now that we have more understanding of biomarkers and things like that, that allow us to be more precise in our treatment of different cancers, there’s a lot of challenges in how do we look at the benefits and the costs, but then how do we weigh in individual experience, how do we bring in these biomarkers, how do we bring in novel therapies now that are very targeted to the individual when traditionally health technology assessment is very much focused on the average, how do we use clinical data, which is primarily about the average patient to answer questions that really have to do with precision medicine. But for oncology in particular, the benefit of looking at health technology assessment is really understanding as new therapies come to market as they, as new therapies arrive on a treatment landscape that has a lot of different options, value assessment can help us understand what are the comparative benefits for whom, and weigh the cost, and of course, cost is a big concern here in the US and globally. 

We want to make sure that what we’re getting is the best patient outcomes for the best investment of our dollars, but what we also know is that, as I said before, the patient journey is very different, and so what might work for the average patient may not work for someone who is a different sub-group, whether that’s from gender or from race and ethnicity, or from age, or from severity of the cancer that we’re talking about, the nuance of that patient experience and their expectations for their care doesn’t get captured in this realm of health technology assessment, and so it makes it problematic to come up with conclusions that fit the need to make decisions, not necessarily at the clinical level, but when we think about health plans, about payers like Medicare or a commercial insurance plan, these entities are trying to figure out how do we use our resources to best effect for the health of the people we care for, the problem is if we’re using the average scientific data or the average patient experience, we may miss the mark for a lot of people, and so that’s one of the sticky parts of this field is, how do we find that balance point between coming up with a picture of  benefit versus cost that fits the average situation versus when do we need to look at things that are more personalized and take into account things that are not well-understood in our clinical data.

What is Value Assessment?

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What Is Value Assessment? from Patient Empowerment Network on Vimeo.

Jennifer Bright, CEO of Innovation and Value Initiative breaks down what value assessment and/or health technology assessment Is and how they are both used.  

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Transcript

Mary Leer:

What is value assessment/health technology assessment and how is it done? 

Jennifer Bright:

Mary, thanks for asking that question. You know, value assessment is a term that’s primarily used in the US and internationally, a wider term is health technology assessment, but they refer to the same thing, which is really an evaluation of health technologies that could be drugs, devices, medical interventions, and looking at the benefits of those interventions versus the costs. So that’s really the simplest definition. But that’s probably the most simple aspect of this field, it really has to do with economic analysis and thinking about how we compare the benefits to a person’s health outcomes and their quality of life versus the cost of what those interventions might cost to an individual’s care to a health plan and to society. As far as how it’s done, as I said, it’s a pretty complex area of research primarily done by health economists, and involves a lot of data, a lot of complex formulas and estimations and modeling to derive what people conclude as some kind of formula that helps us understand complex data and helps us understand those benefits versus costs. The biggest challenge with the field of value assessment and health technology assessment is that we don’t always have the best data to plug into these formulas. And so when we think about data in the realm of oncology care, for example, people’s experience in their care journey might differ their demographics and their genetics might differ and how their disease expresses itself, that the interventions are different and the costs are very different, and so when we use a simplified method like health economic research to try to come up with answers, what we have to realize is that we’re trying to simplify a lot of complexity and that makes it a very challenging environment, and one in which there’s a lot of disagreement about what’s the best method to do this work.

#patientchat Highlights – How is “Value” Defined in Healthcare?

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Last week we hosted a “How is “Value” Defined in Healthcare?” Empowered #patientchat on Twitter.  Take a look at the top tweets and full transcript from the chat.

Top Tweets

How do you assess “value” in your care?

#patientchat top tweet

How does measuring value vary from all involved in healthcare such as patients, caregivers, physicians,  health systems, etc.?#patientchat top tweet

As the definition of value continues to evolve in healthcare, what steps can you take to ensure your voice is heard? Do you have advice for other patients who are struggling to have their voices heard?

#patientchat Top Tweet

Full Transcript

Finding Value in Your Care: Take Action Checklist

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1. Am I getting the best care or even offered the best?  

  • Is the care appropriate for my age? My condition?
  • Am I being given more than one option, if at all possible, with the pros and cons explained to me?
  • Is my provider willing to recommend me to a colleague for a second opinion if I feel that I need one?
  • Does my healthcare provider care for me as an individual or do I feel lumped together with other patients?
    • Do I feel comfortable asking questions? 

2. Are the ordered scans and blood work helping me in my care or are they ordered “just because?”

  • Does my provider explain the reasoning behind these orders (i.e. what information we’re looking for, how this will help progression of my care, etc.)?
  • When the results come back:
    • Do I have access to them? If so, are they easy to find?
    • Are they explained to me in a way that makes sense?

3. Is insurance providing me coverage or am I consistently receiving denials/is my provider having to do a peer-to-peer? 

  • Does my coverage make sense?
    • Are providers transparent about how much something may cost?
  • Are terms explained?
  • Can I easily receive access to a care representative?

4. Does my employer offer benefits that fit what I need? 

  • Health insurance 
  • Short-term and long-term disability 
  • Options for FSA and/or HSA accounts 
  • Employee assistance programs 

5. Are the medications that are prescribed working as intended? 

  • Do I understand how to use them correctly? 
  • Do I feel comfortable telling my doctor if I have any side effects and need to switch to something else? 
  • Are they affordable or are there alternatives? 

6. Is a patient portal available and easily accessible? 

  • Is it easy to find what I’m looking for? 
  • What capabilities does the portal have?
    • Can I message my provider?
    • Can I view lab and imaging results?
    • Can I schedule appointments and see upcoming appointments?
    • Can I see visit summaries of previous appointments?