Outcomes-based payment models
The EY Health Outcomes Platform is an innovative, industry-wide utility, designed to facilitate value-based contracting at scale.
As health care becomes smarter, the need to maintain trust, data security and patient confidentiality becomes more critical than ever before. Health care stakeholders recognize the benefits of value-based contracting; however, multiple challenges have prevented them being a practical reality. These challenges include:
- The higher levels of trust and coordination required across ecosystem stakeholders to develop and implement value-based contracts versus traditional contracting types
- Strict privacy regulations surrounding the use of personal information
- The fragmentation of health data across multiple systems — instead of a streamlined, holistic process of data sharing, stakeholders are working in silos, making for a more time-consuming process
- The high administrative burden on health care stakeholders to manage value-based contracts through activities such as tracking patient outcomes/metrics, calculation of contract performance and associated rebate, which makes them overly time-consuming and prevents such contracts from scaling
The EY Health Outcomes Platform is an industry-specific, technology-enabled service that will shape the future of value-based contracting by:
- Enabling value-based contracting at scale
- Maintaining data ownership, data security and patient confidentiality by never moving data from its source
- Automating the contract management so contracting is seamless, frictionless and fluid and requires minimal manual intervention
While pharmaceuticals, payers and providers seek better health outcomes, their value and respective stakes are not always aligned. Innovative contracts can play an important role in the alignment of value.
Solution features & functionality
The Health Outcomes Platform brings together all contracting stakeholders onto a single platform and enables them to co-create, manage and analyze a wide variety of value-based contracts. Key features of the platform include:
- A completely transparent and standardized yet flexible contract creation workflow to design agreements that align to all stakeholder needs
- A fully automated and compliant data access and integration process — the platform follows rigorous data access and security protocols, and only accesses relevant pseudonymized data for the specific contract via data queries which is managed in accordance with regional data protection regulations
- Near real-time tracking and forecasting of contract financial performance to support revenue tracking and manage risk exposure
- Comprehensive dashboards for pharmaceutical companies and payer/providers to view and track all draft and live contracts in one place
The Health Outcomes Platform is a one-stop-shop that helps create, manage and analyze value-based contracts at global, regional and local levels. With our extensive global and local reach, we can connect to customers in every local market to ensure successful implementation.
The EY Health Outcomes Platform is an innovative industry-wide tool designed to facilitate value-based contracting at scale. It helps stakeholders simplify and streamline data capture and management, increasing transparency and trust whilst providing organizations the flexibility to create their own contracts and determine the requirements for measuring success.
The platform works by allowing stakeholders to interact with data at its source while respecting data privacy, maintaining data protection and ensuring regulatory compliance on a regional basis. To ensure data is always secure, every source is connected to a transactional data layer, which manages the data in three stages:
- The data is first pseudonymized, meaning that all patient identifiers are converted into an encrypted hash key.
- Next, the platform's data processing engine converts raw data into meaningful information that the platform can interpret.
- Once the raw data has been processed, the platform performs a series of final quality checks to ensure that the data is coming from the correct source, for the right contract and is in the required format.
The “triple win” of value-based contracting means everyone benefits. Patients get access to the best new drugs, health care payers get better value for money and life sciences companies are reimbursed a fair price for the medicines, which enables research and development to produce the next generation of drugs. Value-based contracting also creates greater transparency using readily available but fragmented data to help us understand what works best in terms of outcomes, as well as best value for money.
The EY Health Outcomes Platform has been designed with strict InfoSec management guidelines to foster trust amongst stakeholders. All contracts created on the platform and associated viewing rights are reviewed and signed-off by contracting entities.
The EY Health Outcomes Platform can support any type of value-based contract such as financial-based agreements, coverage with evidence development agreements, and outcome-based contracts, including milestone-based and subscriptions.
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