Outcomes-based payment models

In Life Sciences

The EY Health Outcomes Platform (HOP) is designed to address the critical need for value-based contracting, which reimburses life sciences companies and providers for delivering prespecified, real-world results and solutions.

Related topics Life Sciences

What EY can do for you

Fueled by aging populations and new drugs to treat rare and specialty diseases, global spending on prescription medicines is expected to increase between 2% to 5% annually over the next five years. It should exceed US$1.1 trillion overall by 2024, up from US$955 billion in 2019. Governments, businesses and individuals are paying more and more to maintain the health of their populations, workers and families.

Historically, health care reimbursement has been based on volume rather than value and outcomes. Value-based contracting (VBC) is increasingly seen as a viable and sustainable way of aligning payment to value. VBC compensates life sciences companies and providers for delivering prespecified, real-world results and solutions based on three health outcome pillars: clinical efficacy, patient-reported outcomes and health care system efficiencies.

Value-based contracts have the potential to align the interests of patients, payers, providers, life sciences companies and society around a shared goal: reducing health care spending trajectories to more acceptable and accessible levels while continuing to reward important innovations.

While in reality, new digital technologies are making it easier to collect and share data, doing so securely is challenging, trust between stakeholders is hard to establish, and the tailored nature of these contracts makes them difficult to deploy at scale.

Getting started

What’s needed is an innovative platform that incentivizes all parties to drive positive results while allowing them to be more collaborative and efficient. In short, contracts among these stakeholders are needed that are standardized but flexible, automated but customized and simple but scalable.

Enter the EY Health Outcomes Platform (HOP), an industry-wide, innovative utility to support VBC. HOP fosters frictionless collaboration at scale across providers, payers and life sciences companies to meet the needs of a dynamic health care landscape. HOP helps stakeholders simplify and streamline data capture and management, increasing transparency and trust.

How it works

Life sciences companies and other health care players create digital contracts, which include the requirements for measuring success. By leveraging blockchain, data is accessed at its source while respecting data privacy, maintaining data protection and confirming regulatory compliance in the regions where it operates. These sources are connected to a transactional data layer, which manages the data, and the contracting parties can then analyze the outcomes via the user interface.

HOP facilitates a triple win: allowing payers and providers to offer better care; providing life sciences companies with the chance to prove the value of their products; and, most importantly, helping patients access the new treatments they need.

Why EY?

As a trusted advisor across the health care ecosystem and committed to building a better working world, EY member firms can work together with life sciences and health care companies to drive an analytical, fact-based assessment that is fully transparent in order to bring confidence to the relationship.

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