As payers and providers continue to navigate value-based agreements and strive to improve outcomes in their populations, real-world evidence (RWE) has emerged as an important tool to measure the impact and value of interventions.
We spoke with Bill Guptail, who recently joined Aetion as the Senior Vice President of Value-Based Care, about the opportunity he sees for RWE to benefit payers and their stakeholders.
Bill brings over 20 years of health care experience to Aetion. He’s held both payer- and provider-focused roles, often in positions that serve complex populations. He’s led managed care plans and oversaw programs that aim to increase treatment access and affordability for patients, in hopes of creating an improved health care experience for those who struggle to get the care they need, when they need it. Most recently, Bill served as the Chief Operations Officer at Genoa Healthcare, where he ran specialized behavioral health pharmacies.
Read on to learn more about Bill’s perspective on how RWE can support payer and provider decision-making.
Responses have been edited for clarity and length.
Q: How are payers using RWE today? How about providers?
A: Payers are in various stages of understanding and adopting RWE within their clinical strategies and capabilities. Leveraging RWE to further understand which clinical interventions can drive improved outcomes for patients, while at the same time reducing total cost of care, will continue to gain traction as the use of RWE in safety and utilization management decisions expands.
I see a significant opportunity for providers participating in risk sharing arrangements to further leverage RWE in similar ways, especially in their ability to negotiate payment models that are tied to patient-centered outcomes within value-based agreements.
Q: How do you expect RWE to impact collaborations with payers going forward?
A: The entire health care system has been moving toward new revenue models as we shift the focus from fee-based payment to quality- or value-based payment. While this shift to recognize value has been in play for years, it’s been difficult to understand the capabilities needed to consistently measure which parts of the health care system are driving value. RWE can act as the conduit within these models to connect payers, providers, and other stakeholders involved in value-based agreements.
Q: How can RWE facilitate value-based agreements between payers and biopharma or medical device manufacturers?
A: There is significant momentum, especially within the speciality pharma space, to find alternative payment models that can differentiate the value and impact medications have on populations, as well as factors that support patient adherence to therapies. As society looks for more affordability in drug costs, it’s critical that we’re able to measure the overall value of therapies. RWE will enable payers and biopharma manufacturers to participate in these value-based arrangements objectively and ensure all stakeholders are confident in the integrity of the measurement process.
Q: What additional steps need to be taken to further advance the use of RWE by payers?
A: In order to drive further adoption of RWE across payer stakeholders, it’s critical to raise awareness of the comprehensive value proposition of RWE, and of the role RWE can play in decision-making. It will also be important to demonstrate the added benefits of using RWE by clearly communicating the return on investment for payers’ affordability initiatives.
Q: What attracted you to the RWE space?
A: Throughout my career, I’ve been passionate about finding opportunities to leverage innovative solutions with the potential to move the dial on the significant challenges we face with regard to improving access, engagement, and health outcomes for individuals with complex conditions. RWE technologies, in partnership with innovative partners across the industry, have the potential to bring the best evidence-based decision-making tools to providers and patients as they seek a better, more personalized approach to health care.