A Comparison of HEOR Research and Actuarial Analytics

ISSUE: HEOR informs the value (i.e., the benefit gained for the cost) of alternative health care treatment options. Actuaries address future financial risks and opportunities in the context of affordability (i.e., what it will cost).Together, it may be possible that the disciplines can play a highly complementary role in influencing pharmacy and medical drug coverage. Given distinct differences in professional culture, training, methods, and value drivers, the question is whether the two disciplines can indeed find opportunities to integrate, or at least produce aligned insights

OVERVIEW: Health plans, PBMs, and providers ultimately translate value-based information into Per-Member-Per-Month (PMPM) costs for the development of pharmacy and medical benefits. This practical business challenge should create a natural interface between HEOR and actuarial insights. Both disciplines answer important questions using different methodologies and perspectives. Without mutual understanding, these differences can be divisive. Without a deliberately developed bridge, benefits decision-makers may lack guidance in applying the respective insights. The three panel members have unique experience in developing and/or applying both pharmacoeconomic and actuarial insights. They will describe and compare how insights from both disciplines are used to impact benefit decisions, identify differences as well as common ground in methodology, and suggest opportunities for future and deliberate integration.