Healthcare
Reimbursement on the basis of health outcomes
European Union Member States increasingly are experimenting with integrated approaches to the care of chronic health conditions that link payment for healthcare services to health outcomes. This creates both challenges and opportunities for value creation and value demonstration.
These approaches also represent the broader application of value indicators and metrics to disease management and healthcare delivery, thereby serving as a complement to value assessment in medicines.
In a December 2009 meeting of the Type 2 Diabetes Working Group, participants considered a disease management program for diabetes being introduced in The Netherlands. This Dutch initiative seeks to integrate the organization of care delivery by moving to a lump-sum, per-patient system of reimbursement.
As a result, in the second phase of the program, medicines will be reimbursed out of provider budgets rather than payer budgets.
By tying reimbursement to health outcomes, the program defines a set of indicators and metrics for assessing the value of diabetes treatment. These indicators and metrics overlap with those in the type 2 diabetes Working Group's Shared Value Framework, making the Dutch standard of care a potential guide to value demonstration in drug development.
In addition, by shifting the cost of prescribing to the provider and limiting reimbursement to treatment guidelines, the Dutch program suggests an approach to controlling off-label usage of medicines.
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