By Jennifer Bright

Innovation in science and medicine is rapidly offering many patients hope where it rarely existed before. But the disappointing reality is that while the pace of innovation has accelerated in medicine, innovation in the measurement and reimbursement of healthcare value has not kept pace.

For the Medicare and Medicaid programs, as well as others charged with insuring healthcare benefits, medical advancements have raised the bar on the importance of measuring diagnostic and therapeutic value. The unfortunate truth is that today, the practice of value assessment is, in many ways, stuck in the early 2000s, leaving public and private payers, employers and health systems lacking measurement tools they need.

To modernize the way we assess value in healthcare and ultimately achieve highest quality for reasonable cost, we must effectively harness both clinical and real-world data and improve transparency. We must decentralize and democratize value assessment tools by making them available to all decision makers interested in understanding the factors and perspectives that constitute value in health care. And we must develop precision value assessment that captures not only unique patient traits and perspectives, but also allows customized interpretation of data according to the needs of clinicians, health plans, employers and payers.

In short, the healthcare system needs Value Assessment 2.0.

But how do we make it happen?
First, better value measurement must “hard code” the patient perspective into all assessment tools. Patients differ in their individual characteristics, personal preferences, progression of illness, and response to treatments. Value assessments must therefore incorporate methods and tools to account for this diversity, to ensure that our understanding of value matches the real-world diversity in patient preferences and clinical characteristics.

Second, real world data points must be considered when judging a treatment’s worth beyond direct clinical benefit. Impacts[b][c] on caregiver burden, economic productivity and other medical costs are just three factors that must be considered when evaluating value. The U.S. healthcare system is more complex and dynamic than single-payer markets, and thus needs more inputs on which measurement tools can be built.

Third, value assessment must be transparent. Such analysis should occur in an open-source, visible environment, rather than emerge from an opaque black box process. Transparency is a powerful tool for equalizing stakeholder perspective and for accountability. As we commit to improving price transparency, we must also shine a light on how and on what basis the value of health care technologies are determined.

Fourth, assessing value must be a community activity. Patients, policymakers, payers, providers, and manufacturers all have important contributions to make if we are to move to value-based decision making. It’s vital that healthcare decision makers collaborate so innovation can be fostered, tested, and evaluated and the right patient can get the right therapy from the right provider in the right setting at the right time. We should all be on the same team, sharing the same goals.

By following these principles, value assessment models and tools can be created that better measure therapeutic value and give policymakers modernized resources to weigh benefit, risk and costs in a way that reflects the real world. With a team approach to Value Assessment 2.0, we all win.

About the author: Jennifer Bright is the executive director of the Innovation and Value Initiative.