Assessing Healthcare Payer Perspective on Health Economic Model Transparency and Applicability to Own Setting

OBJECTIVES: Recent developments have heightened the need for improved accessibility and transparency of economic models for informing the payer landscape in the United States. This study sought to evaluate how healthcare payers are using health economic models in real practice and opportunities for improve application of models in decision-making.

METHODS: We distributed an online survey to Academy of Managed Care Pharmacy members in decision-making roles at health plans, pharmacy benefit managers, hospitals or health systems, or other accountable care organizations in the United States. The survey included 8 questions assessing current model utilization, types of economic models used, level of access to the models, importance of various model characteristics, key challengers related to model usage, and their valuable features. All study participants were recruited using personalized email invitations.

RESULTS: A total of 29 individuals responded to the survey representing health plans (n=18), pharmacy benefit managers (n=10) hospitals or health systems (n=3) and accountable care organizations (n=2). The inability to change model input parameters was reported by 86% of survey participants as a limitation for informing plan access. 54% of participants indicated the delays in when they get to review the model as a challenge. 70% of participants reporting reviewing 3^rd party economic models and 63% of participants develop their own models. Survey participants indicated the following attributes that would improve usefulness: models that are developed with payer input at the design stage, transparency in model details and methodology and ability to incorporate own data into economic models

CONCLUSIONS: Survey results indicated that a greater model validation should take place and the ability to change all model inputs parameters is a crucial feature from payer perspective.