The majority of health systems use activity-based payment providers but this does not ensure patient and population health is at the heart of all decisions.

We work with clients – payers and providers – to design and implement innovative reimbursement solutions that realign incentives to deliver value to patients and the wider health system.

Innovative value-based reimbursement solutions

‘Value Based Care’ or ‘Outcome Based Agreements’ (OBAs) that realign the incentives between payments and patient health have been cited as a solution to growing and more complex healthcare demands for years. However, very few have been implemented due to uncertainty across stakeholders and the wide skillsets required to put such agreements in place.

We harness our multi-disciplinary team spanning actuaries, data scientists, epidemiologists and clinicians to support all stages of OBA implementation. Our approach to the design, development and implementation of OBAs focuses on working across stakeholders to build consensus around patient value using several stages:

• Stakeholder mapping across patients, payers and providers of therapeutics and care
• Identifying the target patient population including strata where outcomes are likely to vary in order to mitigate against worsening health inequalities
• OBA design through working with stakeholders to identify several feasible OBA clinical and financial scenarios
• Simulation modelling of the OBA scenarios to estimate impacts for each stakeholder over time
• Data governance and infrastructure to ensure the OBA framework can be embedded in a sustainable reporting framework
• Implementation and reporting schedule across stakeholders including interactive and dynamic dashboarding to facilitate stakeholder engagement and ongoing monitoring

• Through simulating a range of OBAs and comparing outcomes across a wide range of stakeholders, we build consensus around solutions that value the health of patients and populations alike.

Capturing the wider value of therapeutics

Health is a key driver of economic prosperity yet we rarely capture the wider value that therapies and other interventions can deliver to health systems and wider society. We work with clients to estimate this across two areas:

• Wider societal value of interventions including averted productivity loss and informal care including additional stratification to assess impacts upon existing inequalities within therapeutic areas.
• More novel additional value elements that are becoming increasingly of interest and consideration in Health Technology Assessments such as transmission, enablement, diversity and insurance value.