Paying For Value From Costly Medical Technologies: A Framework For Applying Value-Based Payment Reforms.

Journal Article (Journal Article)

Innovative medical products offer significant and potentially transformative impacts on health, but they create concerns about rising spending and whether this rise is translating into higher value. The result is increasing pressure to pay for therapies in a way that is tied to their value to stakeholders through improving outcomes, reducing disease complications, and addressing concerns about affordability. Policy responses include the growing application of health technology assessments based on available evidence to determine unit prices, as well as alternatives to volume-based payment that adjust product payments based on predictors or measures of value. Building on existing frameworks for value-based payment for health care providers, we developed an analogous framework for medical products, including drugs, devices, and diagnostic tools. We illustrate each of these types of alternative payment mechanisms and describe the conditions under which each may be useful. We discuss how the use of this framework can help track reforms, improve evidence, and advance policy analysis involving medical product payment.

Full Text

Duke Authors

Cited Authors

  • Lopez, MH; Daniel, GW; Fiore, NC; Higgins, A; McClellan, MB

Published Date

  • June 2020

Published In

Volume / Issue

  • 39 / 6

Start / End Page

  • 1018 - 1025

PubMed ID

  • 32479217

Electronic International Standard Serial Number (EISSN)

  • 1544-5208

International Standard Serial Number (ISSN)

  • 0278-2715

Digital Object Identifier (DOI)

  • 10.1377/hlthaff.2019.00771


  • eng