TPA Network's RESEARCH CONSORTIUM was establishment to be an industry-focused research facility aimed at assessing the value of emerging medical technologies and health innovations. It's an initiative that has been met with great interest and support by many leading reinsurance, technology and professional services companies.
The Challenge: Keeping Up with Unprecedented, Transformative Change
Precision medicine, opioid alternatives, medicinal cannabis, electronic aspirin, medical wearables, capsule endoscopes and even fecal transplants: these and tens of other promising new health innovations are emerging...confusing plan sponsors, TPAs and reinsurers alike. At the same time, new means by which to do business are being tested including value-based provider contracting, AI-enhanced plan administration and block-chain based security. These changes challenge the stability of those who are slow to accept and adopt change and, while promising, many of these innovations are unproven, expensive, ineffective and wasteful; few have been adequately researched (especially for use by ERISA plans).
As a practical matter, on average, it takes seventeen years for a new medical technology to be “translated” into widespread use. During this time, little in the way of meaningful research or actionable technology assessment occurs. Instead, an inefficient and dangerous trial-and-error process ensues to determine what works and what doesn’t; what’s cost-effective and what isn’t; what’s dangerous and what’s not. We benefit from the new advancement in a very suboptimal way and one that makes any new innovation potentially risky and a clear and present challenge for payors. Clearly, this cannot continue.
Our Solution: An Industry-Focused Initiative
Few TPAs can cost-justify a BUCA-quality Pharmaceutical, Therapeutics & Medical Technology Assessment Committee to conduct research and provide guidance. Nonetheless, this assessment is clearly needed, free from the bias that comes with funding from big pharma, medical device firms and health systems. To fill this research and assessment void we are pleased to announce the creation of TPA NetworkRESEARCH CONSORTIUM to help TPAs maintain their position at the forefront of change, a hallmark of the industry we helped to pioneer nearly sixty years ago. Each RESEARCH CONSORTIUM study will focus on assessing one new (or common, yet suspect) medical technology or health innovation as to its efficacy, cost-effectiveness, value, best means of deployment and compliant use.
The Scale to Make a Real Impact
A “consortium” is the pooling of the resources of many for the undertaking of an endeavor to achieve a common goal that requires resources beyond those of any one. Meaning: no TPA has the size, technology and independence needed to carrying out this mission. Together, however, we can leverage our enormous market clout. Consider this: collectively, the TPAs that operate on just the five leading (commercial/union) payor platforms service 30+ million plan participants, a population covered by fewer than two dozen stop loss facilities. These resources can provide access to billions of potentially valuable medical and Rx claims; serve as a huge patient pool from which to source study participants; and create purchasing power able to support efficient research, positively impact patient care and facilitate vast provider outreach. With a TPA-administered population this large, a research study that involves just one half of 1% of this pool could impact or influence as many as three quarters of the country’s ~100,000 primary care practices. With this level of provider engagement, the RESEARCH CONSORTIUM could meaningfully accelerate the translation and diffusion of a new medical innovations.
Perfect Timing: Leverage New Technologies in Healthcare
The pressing need for new technology research, assessment and guidance emanates from the transition to the evidence-based, value-oriented paradigm and the application of new technologies to healthcare (e.g., that enable access to, and make sense of, billions of siloed claims data, once thought to be worthless). To support our research, and for consistency, efficiency and speed-to-deployment, we are forging collaborative arrangements with leading payor platform companies, health data management and analytics firms and patient/provider engagement tech firms.
Transparent, Contemporary Study Approach and World-Caliber Researchers
Each RESEARCH CONSORTIUM study will be an independent “B Certified” transparent entity, overseen by an independent fiduciary and regulatory compliance officer, operated to deliver most favored-nation pricing and privately financed (vs. funding from PBMs, drug companies, health systems and laboratories having potentially misaligned incentives). In that bench-to-bedside translational research is best conducted using a pragmatic study approach and real world evidence, our research teams will include a broad range of researchers, scientists, physicians and professors affiliated with the nation’s top academic research institutions. By example, our first study, focused on precision medicine. includes researchers from Duke University; MIT, Drake University, the Salk Institute and the Uniformed Services University of Health Sciences.
Affordable, Common Sense Funding Approach
Reinsurers should have a keen interest in how their clients handle health innovation assessment for obvious reasons: they have skin in the game and are directly impacted by these advancements. As they stand to benefit greatly from this research, we heartily encourage their financial support. The market for this type of research is broad however and, as such, funding for this initiative will also come from study sponsorships; private contributions, academic research grants, subscription fees, program licensing royalties and fees for supporting patient engagement, provider outreach and case management. We look forward to hearing from potential study participants (e.g., TPAs); collaborators (e.g., technology vendors) and study sponsors (e.g., reinsurers, actuarial and health analytics firms) wishing to leverage the prestige associated with an academic study; increase their brand awareness; and benefit from a front-and-center position as an industry innovator.
Initial Research Study: Precision Medicine
The RESEARCH CONSORTIUM’s first study is appropriately focused on the proper, efficient, cost-effective and compliant use of precision medicine by value-based, ERISA-regulated plans. Experts agree that pharmacogenomics will change the way medicine is practiced by becoming the starting point of treatment and the foundation of value-based healthcare. Phase I of the Precision Medicine Translational Research Study will involve the GINA-compliant PGx testing of 15,000 plan participants managed by some two dozen forward-thinking, single- and multi-employer TPAs. The contract to form this study has been awarded to the Precision Medicine Research Group...see www.ThePMRG.com
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