Better Late Than Never? Payer Appetite and Vision for a National Value Assessment Body

OBJECTIVES: The United States (US) has a decentralized healthcare system with a mix of public and private entities assessing the value of healthcare interventions for coverage and reimbursement decisions. Some healthcare stakeholders and experts have proposed the creation of a US national value assessment body. Our objective is to understand payer perspectives on a national value assessment body and its ideal role(s) in value assessment.

METHODS: A double-blinded web-based survey of US healthcare payers was fielded through Cencora’s research panel, the Managed Care Network, in July 2023.

RESULTS: A total of 48 managed care advisors (56% health plans, 25% pharmacy benefit managers, 19% integrated delivery networks), composed primarily of pharmacy directors (58%) and medical directors (35%), completed the survey. 71% of payers thought the US should create a national value assessment body, whereas 15% said it should not, and 15% were unsure. Most payers preferred a single body (65%) over multiple bodies (10%), with 25% indicating no preference. The preferred funding source was government funding only (46%) followed by a mix of private and government funding (42%) and private funding only (6%). In a multiple-response question, payers said the ideal purpose for a national body would be to develop value assessment standards in the US (85%), evaluate the quality of value assessments conducted by third-party organizations (69%), and conduct value assessments (63%).

CONCLUSIONS: Nearly three-quarters of payers in this survey agreed that the US should create a national assessment body. Payers were split on government-only funding vs a mix of government and private funding. Respondents were most interested in a national body focused on developing value assessment standards, although there was support for evaluating the quality of value assessments conducted by others and conducting value assessments.