We are entering a new phase of healthcare innovation. With a slate of FDA approvals in late 2017, gene therapies, immuno-therapies, and other personalized, ground-breaking treatments, have arrived. These will offer hope to patients suffering from rare disease, cancers, and other debilitating health challenges. Yet the question remains: how do we pay for it all?
Tapestry, together with partners in industry, government, payers, reinsurers, providers, leading associations, and other experts, is tackling this question across multiple efforts. For example, Tapestry is engaging with key stakeholders and thought leaders to address payment reform for oncology through existing alternative payment models designed by payers and providers to lower costs and improve quality. Separately, the Innovative Healthcare Financing initiative is addressing whether capital markets can create new financing vehicles for cancer patients to better manage out-of-pocket costs in the absence of broader structural reforms. For more details on these and related efforts, please see below.
Recent efforts include:
Optimal Oncology Alternative Payment Model (APM) network
As value-based medicine emerges as the new paradigm for the US healthcare market, the Optimal Oncology APM initiative seeks to engage key stakeholders to understand and develop shared principles that should guide alternative payment models in this specialty. Given the dramatic pace of treatment developments, anticipated rising costs, and the complex, personalized nature of patient responses, oncology presents a unique challenge to the system. The end goal of this effort is to ensure that payment reforms are designed to enable patient access to the most effective oncology treatments in a manner sustainable to health systems.
Innovating Healthcare Financing (IHF)
Tapestry, in partnership with institutions such as the MIT Laboratory for Financial Engineering and Dana-Farber Cancer Institute, has engaged with leading healthcare and financial-sector stakeholders to address new models of paying for transformative therapies. IHF addresses both rising patient out-of-pocket costs and transformative therapies’ budget impact on payers and providers.
Beginning in late 2017 and building from the 2016 meeting co-hosted with MIT and Dana-Farber, Tapestry engaged with payers, pharmacy benefits managers, physicians, finance professionals, actuaries, academics, and industry to discuss how novel financing vehicles could enable greater patient access to oncology treatments. The Innovative Healthcare Financing (IHF) working group’s discussions culminated in an in-person meeting in November 2017 and included a series of education calls that aimed to create a common framework for understanding oncology markets across the participating stakeholders. The IHF group addressed how complex financial tools could be used in specific scenarios that were highlighted as areas of need, including patient out-of-pocket costs and the financial impact of transformative therapies on payers and providers. Learn more
Workshop on new financing structures for transformative therapies – co-organized by Tapestry Networks, the MIT Laboratory for Financial Engineering and Dana-Farber Cancer Institute
On October 14, 2016, a select group of biotechnology and drug developers, academics, financiers, economists, providers and payers convened in Cambridge, MA to discuss how innovative financing could help expand patient access to transformative therapies in the United States. The organizers sought to channel the cross-sector expertise present to address critical questions, including: How do we get transformative therapies to patients faster and cheaper while incentivizing the development of future transformative therapies? Who pays in the short and long-term: taxpayers, consumers or payers? Can financial engineering help make paying for transformative therapies, especially those that are curative in nature, more sustainable? Learn more
Engaging stakeholders & building pragmatic models to sustainably support curative therapies
In a series of discussions conducted in late 2015 - 2016, leaders from biopharmaceutical manufacturers, public and private payers, patient advocacy organizations and individual economists, financiers and subject matter experts shared their views with Tapestry on the value of curative therapies and how best to manage their delivery within the US healthcare system. These stakeholders also offered feedback on policy barriers and constraints, innovative payment models and paths forward. Learn more