One of the most difficult tasks for human beings is to agree on the worth of anything.
Your masterpiece of modern art might be my eyesore, my collector’s item might be your clutter. However, perhaps nowhere is the complexity of assessing value more complicated than in health care.
Because of the mediated nature of health care and its variety of direct and indirect payers (government, individuals, insurers, employers), the nature of value is complex.
Consider the recent OpEd by Dr. Zeke Emanuel arguing that while new cancer therapies are almost miraculous, and could soon cure many more people, that society as a whole can’t afford them. This is a perfect illustration of the conundrum of value in health care -- the more valuable the product, the more likely there will be social demand to provide it for a reduced cost.
The current environment puts a tremendous burden on innovators to ensure that they are communicating the value of their products to the entire range of health care stakeholders, before, during, and after product launch. Innovators need to consider that just as their products have multiple audiences, they also have multiple values – clinical, social, and economic – and be prepared to make the case on each of these bases.
Increasingly, innovators are factoring value-assessment criteria into R&D programs, but this is a partial answer. Innovators must also factor in the broader policy and social environment in which their product comes to market.
How does one do that effectively? First, consider that a product comes to market within the context of a disease. It’s important to establish the burden of that disease and the prospect for patients. As an example, I think too often as a society we talk about disease in the abstract, but when we truly understand the suffering that accompanies a disease our own assessment of the value of treating that disease changes.
In addition, one area where there has been insufficient work done is with employers. Large employers are footing the bill for health care and, yet, they are often not engaged enough in understanding the long-term prognosis for disease and the options for treatment.
However, merely focusing on the individual products risks underselling the total value proposition. Acknowledging legal and regulatory limits, innovators must also communicate their aspirations across their portfolio and pipeline, conscious of how those aspirations fit into broader societal needs.
In addition, particularly where products might be groundbreaking, there is a need to engage payers and regulators up-front to help communicate which clinical benefits are most important to patients, as well as begin to explore innovative payment mechanisms. It is important to demonstrate that products are brought to market with a recognition that they fit within the broader array of health care costs.
Finally, innovators need to be thinking creatively about what must change in policy to facilitate new payment models and new approaches to encouraging high value care across the board.
There has been good work done in articulating policy changes that can support the move to value-based payment, but more can be done. It’s critical that innovators engage with patients, providers, insurers, and policymakers about ways in which the system can be reformed to make it more responsive to patient needs while still being affordable for those who foot the bill.
There is no magic formula, but if innovation is to be valued, there is a need to communicate its value.
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