Presentation (CTI)

Problem Statement: Beneficiaries of the Brazilian supplementary (private) healthcare system face significant barriers to access high-cost therapies, especially in complex conditions like cancer. The risk-sharing agreements (RSA) were designed to generate value across multiple stakeholders in the healthcare system while assessing mechanisms for value-based remuneration to overcome such barriers for access, with a main focus in overcoming financial barriers for access.
Description: Two RSAs were implemented to address financial barriers associated with high-cost oncology treatments. The first RSA focused on Extensive-stage Small Cell Lung Cancer (ES-SCLC) patients, a condition characterized by rapid disease progression and limited treatment options. The second RSA targeted patients with Hepatocellular Carcinoma (HCC), a common type of liver cancer with significant morbidity rates. The HEOR evidence used in these agreements included a comprehensive analysis of patient-reported outcome and treatment costs. Data collection involved tracking patient progress and financial reimbursements for unmet clinical goals. The approach assessed the cost-effectiveness and overall efficacy of the oncology therapies, as well as the impact of RSA on financial and clinical outcomes across stakeholder groups.
Lessons Learned: The implementation of RSAs demonstrated significant effectiveness in optimizing treatment costs and improving resource allocation. Approximately 85% of treated patients achieved the predefined clinical outcomes. Additionally, the reimbursement for unmet clinical goals resulted in a substantial 14% reduction in overall treatment costs. These findings highlight the value of adopting RSA as a strategic approach to performance and outcomes-based healthcare management. Key lessons include the relevance of incorporating RSA to mitigate financial barriers and enhance therapy access for patients.
Stakeholder Perspective: The perspective addressed in this analysis is primarily that of healthcare payers, who are responsible for managing the financial aspects of patient care. However, the RSAs also provide insights from the perspectives of patients, providers, and industry stakeholders. By facilitating more equitable access to costly therapies, the agreements benefited patients who otherwise would've faced significant financial hurdles. Providers gained from streamlined resource allocation, allowing them to focus on clinical excellence. The industry, meanwhile, has seen opportunities to demonstrate the cost-effectiveness of their therapies, supporting broader adoption in the healthcare system. Therefore, these RSAs collectively provided a comprehensive framework for improving access, optimizing costs, and advancing the quality of care within the healthcare system.