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Healthcare payers gain a bigger stake in biomedical innovation

on November 09, 2011

As funding for biomedical innovations recedes, healthcare payers — state and federal governments, commercial insurance plans, employers and, increasingly, individual consumers themselves — are poised to become bigger players with innovative companies in bringing viable new technologies to the market, according to panelists at the Partnering for Cures meeting in New York City this week.

Payers can aid innovative companies by sharing their patient data and their own expectations of patient outcomes with them, Reed Tuckson, MD, executive vice president and chief of medical affairs for UnitedHealth Group, told the panel.

Already venture capital companies and equity partners are collaborating with large insurance companies to help identify the most promising developments, Ron Cohen, president and CEO of Acorda Therapeutics Inc. said. He has seen that firsthand as emerging companies he has worked with have already approached payers, he said.

“We’ve seen some major initiatives where some of the best healthcare databases in the world are at these major reimbursement groups and companies are now collaborating with them to mine those databases and look for better diagnostics, better targeting and better personalization of therapies,” he said.

Companies in the development stage that get exposed to the payers’ world gain a valuable perspective. “My overall impression is that emerging companies and development stage companies still have no idea what’s going on out there,” he said. It can help them avoid what he has labeled “failure to launch.”

“If these companies don’t factor this into their development program, they’re going to find in many cases that they’ve successfully navigated the regulatory role and they get their product approved only to find that they missed the train and they’re not going to get a reimbursement as viable as it needs to be,” Cohen said.

Tuckson added that insurers can help emerging companies better understand what the endgame should look like. “Where all this ends is with the patients themselves — the quality of life issues, productivity factors in the workforce,” he said. “It will be important to be able to take all that, move it much earlier in the process and build it in so we ultimately come out with a solution that makes sense for patients and for the purchasers of healthcare.”

Here are some additional comments via video from another panelist, Sir Michael Rawlins, chairman of the National Institute of Health and Clinical Excellence in the UK.

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