When I was talking with Dr. David Carmouche from Ochsner in EP316 about the importance of collaboration amongst anybody trying to actually pull off value-based care, we took a little detour, which I wound up cutting out, into the potential and challenges for health systems to collaborate and do value-based contracts with pharmaceutical manufacturers. It’s a really interesting sidebar, though, that I wanted to share with you—especially on the heels of the recent interview with Troy Larsgard from Johns Hopkins (EP318) on how Pharma can better meet the needs of their health system customers.
Here’s an interesting point that Dr. Carmouche makes in the sidebar that I thought was worth highlighting. Chalk this up as one of the challenges when trying to create some kind of risk-share agreement with a pharma company to get the manufacturer to put their money where their mouth is when they say that downstream costs will be saved or complications avoided or better outcomes attained.
The challenge comes in assembling enough patients to make it worth everyone’s while. As we’re considering the assemblage of patients, we have to first consider who’s paying for the drugs. It’s a payer, usually, who contracts with a PBM (pharmacy benefit manager). So, any given health system is going to have to have enough patients not only on that one particular payer in its payer mix but also on that one payer with a plan design that uses that one PBM. As I consider this, I still have questions.
Dr. Carmouche is executive vice president of value-based care and network operations at Ochsner.
You can learn more by visiting Dr. Carmouche’s LinkedIn page or by reading From Competition to Collaboration by Tracy Duberman and Robert Sachs.
David Carmouche, MD, views health care from three distinct perspectives: as a physician provider, an executive for an insurance company and as a leader in a health system. Specifically, he built a large, multidisciplinary internal medicine and preventive cardiology practice in Louisiana; served as the chief medical officer for Blue Cross Blue Shield of Louisiana; and currently has a triad of responsibilities with Ochsner Health, the largest nonprofit academic health care system in the Gulf South. He was recently promoted to serve as executive vice president of value-based care and network operations in addition to his duties as president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network.
He is known as an expert in value-based care. He led one of the top 25 performing accountable care organizations in the United States, managing billions in care spend and generating millions in year-over-year shared savings.
Dr. Carmouche earned a bachelor’s degree from Tulane University and a medical degree from Louisiana State University School of Medicine in New Orleans. He completed his residency in internal medicine at the University of Alabama at Birmingham.
01:57 Why has creating collaboration across Pharma been difficult?
03:10 “Is it better over an episode of care to add a more expensive drug … or would we be better served using less expensive drugs?”
03:51 Why has it been difficult for health systems to execute agreements directly with pharma companies?
04:36 “The question is really just whether or not there’s enough value that’s created to make it worth our while.”