Value and coverage: How reimbursement decisions impact innovations needed to improve health
January 16, 2014

FasterCures, a Center of the Milken Institute, today released its report, Value and Coverage: How reimbursement decisions impact innovations needed to improve health, which articulates findings from a workshop convened on the topic and key actionable recommendations for patient-driven organizations to consider.

In this report, FasterCures notes that when it comes to the issue of value and coverage for medical innovations, the medical research community is in search of a better understanding of the evidentiary standards that payers consider when reimbursing treatment and care. Top of mind throughout the workshop, held in the summer of 2013, was this concept that who determines value and what informs that determination are vastly unclear but have large implications for both the cure and care ecosystems. More than 50 leaders from across all sectors in healthcare and medical research participated in the workshop, convened in partnership with the Cystic Fibrosis Foundation.

aEURoeAt FasterCures, we view everything from the lenses of the cure systemaEUR(TM)s ultimate stakeholder aEUR" the patient,aEUR? said Margaret Anderson, executive director of FasterCures. aEURoeGetting a therapy to market is no longer the goal. We must also ensure that life-saving therapies are accessible and delivered to patients in a manner that is high quality and cost-effective.aEUR?

The report states that establishing safety and efficacy is no longer sufficient when developing a new therapy; innovators must also prove value to patients, providers, and payers in order to generate a revenue stream that covers their R&D costs and provides adequate profits to fuel the next discoveryaEUR(TM)s translation and commercialization.

The report outlines a series of recommendations specifically for patient organizations to consider. Recommendations fall under three major themes: collaboration; leveraging data; and deploying smarter, better care.

While the report details actionable items for patient organizations, it is critical for all stakeholders in this conversation aEUR" from payers to providers, academic scientists to industry executives aEUR" to recognize the value of engaging with the patient community and determine effective strategies for incorporating patient perspectives into decisions.