Optum announced that they will collaborate with Merck to explore value-based and pay-for-performance models, known as Outcomes-Based Risk Sharing Agreements (OBRSAs), and their potential for broad adoption among health insurance companies, pharmacy benefit managers (PBMs), and pharmaceutical companies. The initiative will involve the use of real world data to co-develop and test advanced predictive models and co-design OBRSAs to reduce clinical and financial uncertainty with respect to payment for prescription drugs.
Under OBRSAs, health plans and other payers reimburse drug manufacturers on the basis of clinical outcomes achieved. Prices can fall or rise if the results succeed or fail to meet expectations outlined in the agreement. Increasingly, OBRSAs have become part of the conversation across the health care system due to the desire by health plans, care providers, PBMs, and pharmaceutical companies to base reimbursements on evidence-based outcomes.
Optum Life Sciences president, Curt Medeiros said that Ensuring that health care dollars are spent on interventions that improve patient care and health outcomes is a shared goal for all stakeholders. This collaboration offers an opportunity to leverage their collective strengths to increase knowledge about the design and implementation of outcomes-based contracts in the U.S. health system.
Susan Shiff, senior vice president, Center for Observational and Real-world Evidence, Merck said that their collaboration will create a unique data-driven platform to enable modeling and analysis of innovative contracts that are needed to move to a value-based health care model. The collaboration between Merck and Optum will help advance both organizations’ common goals of improving patient health outcomes, expanding access to innovative therapies, and ensuring the best use of health care spending.