Today’s life sciences industry is ripe with opportunities and challenges, with cost management, a rapidly changing regulatory environment and constantly emerging innovations forming the base of a shifting landscape. Strengthened by our industry-leading subject matter experts, large-scale real-world datasets, predictive analytics and data-driven platform, Inovalon creates practical, data-driven custom solutions for clients, helping to guide strategy and accelerate financial performance. Inovalon’s clients include 22 of the top 25 global pharmaceutical companies.
Many new medications can offer greater disease specificity, fewer complications and superior outcomes. They can also often come, however, at a higher cost. Those who pay for these medications are eager for their members and patients to benefit from advancements in pharmacological care but are sensitive to the higher costs. For these situations, outcomes based contracts (OBC) can be the answer.
An OBC can generally be defined as an arrangement between a pharma/life sciences company and a health plan, where the price paid for a drug is based on negotiated criteria related to the beneficiary’s clinical experience after using the drug. For example, a new drug may be more expensive to cover than an existing drug, but it may also have fewer side effects or follow-on treatment requirements, thus lowering the total cost of care. Assuming negotiated criteria are met, a health plan may pay the full price for the treatment. If certain criteria are not met, the health plan may receive a rebate from the pharma/life sciences company.
Unlike first-generation solutions, Inovalon’s second-generation OBC platforms do more than simply tally the data and calculate impact after the fact. Instead, Inovalon’s second-generation OBC platforms use real-time, data-driven approaches to identify patients with unmet needs, interact with them and their providers to help support the realization of positive outcomes, and provide real-time reporting for all parties to see progress and impact. The result is an actively supported program, empowering better outcomes and greater program transparency.
Powered by the Inovalon ONE® Platform and Avalere’s strategic advisory services, our OBC solution empowers the realization of reduced total medical spending, medical utilization, and cost while improving quality measure outcomes and real-time tracking of program progress. Inovalon’s MORE2 Registry®, the industry’s largest proprietary dataset, enables access to real-world data and sophisticated analytics to track provider performance in real time that supports development of targeted point-of-care solutions to address the unmet needs of patients and improve overall patient outcomes. These point-of-care solutions facilitate quality and compliance outcome program improvement and drive improvements in patient satisfaction and retention.
With in-depth analysis from Avalere’s 150+ policy experts, Policy 360® provides concise, detailed, and unique coverage of federal policy issues, including reimbursement, payment and delivery reform, and Medicare, Medicaid, and the exchanges. Policy 360® serves as the singular source for anticipating how federal policy developments will impact your business, arming you with the insights necessary to hone your strategy to respond to the changing environment.
Knowing Makes All the Difference – Adjust your commercial strategies to anticipate how federal policy change will impact your business.
Leveraging Avalere’s expertise, State Reform 360® strengthens business plans and identifies gaps and opportunities in the marketplace to accelerate market positioning. Avalere State Reform 360® is your essential source for state health policy updates and emerging trends that can impact your business so you can anticipate future action and guide your strategy.
Guide Targeted Commercial Strategies – Master the state health policy landscape and anticipate future action to guide your strategy and improve your positioning in the state Exchange, Duals, and Medicaid landscape.
Avalere’s proprietary PlanScape® database leverages wide-ranging data sources on the insurance market, including Medicare, Medicaid, the exchanges, and employer-sponsored coverage. With accessibility to robust analytics and insights, our business advisors build customized strategies and solutions that accelerate your financial performance. Our solutions allow you to assess, understand, and compare differences in health plan coverage by therapeutic class or drug type, patient costs, enrollments, and benefit designs in Medicare Part D and the exchange market to identify opportunities and gaps in the insurance marketplace.
Master the Insurance Landscape – Identify and maximize opportunities by understanding benefit designs, networks and formularies across your markets.
Avalere, an Inovalon company, leverages its deep subject-matter expertise powered by Inovalon’s innovative technologies and comprehensive datasets to optimize your business practices. Coming from government, patient groups, health plans, pharmaceutical companies, device manufacturers, health IT companies, clinicians and more, Avalere’s experts have dedicated their careers to improving healthcare. Strengthened by large-scale patient data, this substantive, interdisciplinary team contributes perspective and focus to create practical, data-driven custom solutions. Avalere’s reputation is built on this solid, proven approach.