Adaptive Reimbursement evolved as a collaboration of our NEWDIGS LEAPS and FoCUS Projects. The goal of LEAPS is to advance the knowledge and practice of Precision Medicine by modernizing how we Plan, Produce, and Use real-world evidence (RWE) and the goal of FoCUS, with its Precision Financing tools, is to collaboratively ensure patient access to durable and potentially curable therapies using innovative financing and reimbursement solutions that also enhance sustainability for all stakeholders. By combining the expertise of these two communities, we are able to address the need for these new financing and payment approaches while also progressively strengthening the availability and use of RWE for treatment optimization.
Why the name change?
The word “adaptive” has caused some confusion among some who think we are talking about Bayesian approaches and adaptive clinical trials/platforms, as in the LEAPS Adaptive Point of Care (APoC) platform. In contrast, “precision” reflects targeting and matching, and the matching of payment to targeted groups with variable payments is a key part of this workstream.
Just as Precision Medicine seeks to counteract the “one size fits all” approach to healthcare by targeting the right treatment to the right patient at the right time, Precision Reimbursement (PR) acknowledges that there is no “one size fits all” approach to reimbursement tools or contracts, and no singular approach to how RWE is used. While a Payer, for example, can “adapt” from track-and-pay models to performance-based contracts, we believe there is a step further in the evolution by tapping into underutilized RWE to identify sub-populations for drug regimen improvement that could further refine those agreements in a more precise way, and even predict how future treatments in the pipeline might be handled.
PR structures align incentives across all stakeholders to achieve these goals in scalable, sustainable ways. PR pilots will be designed to optimize collaboration value via generalizable learnings while supporting the organizational autonomy pilot partners need to tailor specific design elements for successful implementation within their business environment.
An invited manuscript that provides an in-depth description of the evolution of Precision Reimbursement payment approaches through the lens of LEAPS and FoCUS is now under review by Clinical Pharmacology and Therapeutics.
For more information on Precision Reimbursement, or to join one of the associated working teams, please contact Azrina Azhar (azrina@mit.edu).