Why Assessing Value Is Important and Why It’s Important to Get It Right

Why is assessing value in health care important? Why is it important to do it right? These two questions were at the heart of an opening presentation that set the tone for the National Pharmaceutical Council’s Assessing Value: Promise & Pitfalls conference.

Why is assessing value in health care important? Why is it important to do it right? These two questions were at the heart of an opening presentation that set the tone for the National Pharmaceutical Council’s Assessing Value: Promise & Pitfalls conference. “Clearly understanding value, measuring value is important, but it has to be done right,” said NPC Executive Vice President and Chief Science Officer Robert Dubois, MD, PhD, as he outlined the challenges with assessing the value of health care treatments.

With the increased public scrutiny on health care costs, as well as the U.S. marketplace’s shift toward paying for the value of health services rather than the volume of services, there is a growing interest in how to understand and assess value. For these reasons, several organizations have developed value assessment frameworks, each with differing approaches and targeted to different end-users, and federal government agencies have taken notice.

A recent Kaiser survey indicated that respondents want to see more government intervention in health care. “Beware of what you ask for and the consequences,” cautioned Dr. Dubois. “Value frameworks will be used to guide decisions. It’s a double-edged sword. In the UK or in Germany, they have systems like this for making choices and sometimes that leads to lack of access for drugs that will really help patients.”

He also pointed out that how value is defined matters greatly. Assessing the value of a treatment or health service is different than measuring its budget impact, which is a measure of resource use. Dr. Dubois said we need to be thoughtful about the terms we use and how we apply them, or we could misinterpret the results of a framework’s output and seriously “affect patients in the allocation of resources.”

There is much that we need to learn before these frameworks “are ready for prime time” or broader use in the United States, he explained. In order for the field to advance, there are six issues that value assessment developers “need to wrestle with before we’re ready to really, really say we’re there.” These include:

  • The type of evidence that is used—and how it is used—is a critical underpinning for all assessments.
  • Frameworks need to have a deeper involvement of patients and their perspectives.
  • One size doesn’t fit all. Frameworks need to have flexibility to include a variety of inputs.
  • Frameworks should be transparent; end-users should be able to see the evidence that was used and know how the model was built so that results could be reproduced.
  • Cost effectiveness should be considered from both a health care and societal perspective, such as considering indirect benefits, productivity improvements and the burden on caregivers.
  • Budget impact has a different meaning than value assessment. If the budget impact is reviewed, then it should be considered separately from value determinations.

Dr. Dubois acknowledged that these challenges wouldn’t be solved in one day, and added that the “dialogue that begins today is going to continue for a long time in the future.”

View the archived video and look for additional conference highlights and conversations on this blog during the next few weeks. To learn more about value framework assessments, please visit NPC’s Guiding Practices for Patient-Centered Value Assessment and Current Landscape: Value Assessment Frameworks.