HERB RIBANDVP INTERNATIONAL POLICY & GOVERNMENT AFFAIRS16 OCTOBER 2017

AMGEN’S APPROACH TO “VALUE-BASED HEALTHCARE” IN EUROPE

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TODAY’S DISCUSSION FOCUSES ON THREE TOPICS

1. Mounting healthcare system pressures in Europe require new approaches to innovation and healthcare delivery

2. Europe can ensure sustainable, high quality healthcare systems by improving value (“value = improved patient outcomes / total cost”)

3. To achieve this we need to build win-win partnerships to measure and improve outcomes and recalibrate the policy environment

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AGEING EUROPEAN POPULATIONS FACE A COSTLY AND GROWING BURDEN OF SERIOUS DISEASE…

Source: EFPIA “Healthier future” (2016), citing BCG analysis of OECD and WHO data (2014)

… But today live with unacceptably high variations in health outcomes

• 9x variation in radical prostatectomy complication rates within a country

• 7x variation in breast cancer re-operation rates within a country

• 4x variation in lung cancer 5-year survival across OECD countries

Reasons: Focus on inputs (only), data fragmentation, clinical practice/care pathway variations, transaction-based incentives, different HTA/purchasing/cost containment mechanisms, etc.

Health systems need to reduce inefficiencies and drive

improved outcomes in relation to all 100% of HC budgets

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WE NEED TO REORIENT THE THINKING IN EUROPE ABOUT SUSTAINABLE HEALTHCARE SYSTEMS

From (today’s focus):

Managing Cost

To:

Enhancing Value

• Innovation “not affordable”

• Focus on short-term budget impact

• Systems measure inputs (spending, silo’d budgets)

• Disregard for quality & outcomes variations

• Innovation that enhances quality and efficiency

• Value to patients and society

• Systems measure and improve outcomes in relation to total cost

• Holistic approaches to reduce variations and improve outcomes

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1. See the work of Porter et al: http://www.isc.hbs.edu/health-care/vbhcd/pages/default.aspx

2. Quality of life, improved productivity, cost avoidance, etc.

WE CAN ENHANCE VALUE BY IMPROVING PATIENT OUTCOMES RELATIVE TO TOTAL COST

Cost of delivering the outcomes

Patient-relevant health outcomes achievedVALUE

1

=

Starting point:

Define, enhance and

measure patient-

relevant outcomes

Better quality care can

be less expensive

over the long-term

Better quality care at

equal or lower cost

leads to higher value

for the system

Improve outcomes

Reduce overall costs

Increase value

Value-based healthcare: Delivering highest value from a healthcare system

point of view by focusing on best patient–relevant outcomes/benefits2 in

relation to total cost to the healthcare system.

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ENHANCING VALUE BRINGS BENEFITS FOR PATIENTS, HEALTHCARE SYSTEMS AND SOCIETY

Health Status

Process

Sustainability

Survival

Degree of health or recovery

Sustainability of health and avoidance of recurrences

Reduced complications from therapy (e.g., care-induced illnesses)

Time to recovery / return to normal activities

Efficiency of care / treatment pathways (e.g., diagnostic errors, complications, ineffective care, waste)

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AMGEN AIMS TO PROVIDE INNOVATIVE VALUE-BASED HEALTHCARE SOLUTIONS…

to help ensure that all appropriate patients benefit from our medicines…

that are truly patient-centric and valuable in the real world…

that are integrated across the patient care pathway, personalized to patient conditions,

circumstances and tailored to their preferences…

and maximize quality and efficiency, proven through real-world evidence.

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AMGEN IS DEVELOPING NEW APPROACHES TO ADDRESS DISEASES WITH HIGH UNMET NEEDS

High Risk CV • Multiple Myeloma/ Oncology • OsteoporosisDiseases

Areas for

Innovation ClinicalDevelopment

Patient ID &Diagnosis

Patient Support & Adherence

RWD Capabilities & Analytics

Role of technology and

data

• FH Patient ID

• EMR Integration

• Milestone mapping

• EHR decision support

• Predictive analytics

• Adherence solutions

• Bluetooth monitoring

• Sensors and devices

• Connected health

• Tailoring tech to homecare

• RWD partnerships

• RWD science

• Emerging analytics technology

• Clinical trial recruitment

• PV and safety

• New clinical end points

• Digital biomarkers

• Genomic data mining and R&D

Examples

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AMGEN IS LAUNCHING “VBHC” PROGRAMS IN TEN EUROPEAN COUNTRIES

High risk CVD patient identification; adherenceMultiple myeloma patient care pathway

Cancer/bone mets care pathway Osteoporosis patient identification; adherence

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CASE STUDY (UK): IMPROVING THE CARE PATHWAY FOR CANCER PATIENTS WITH BONE METASTESES

Mrs. FB, native of Liverpool; 46 years old

• Small business owner, wife and mother

• Diagnosed with metastatic breast cancer

Clatterbridge Cancer Centre NHS Foundation

• One of UK’s largest cancer networks

• Serving 2.3 million people

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• Travelling ~2 hours to hospital

• Personal / travel costs ~£200/mo.

• Inferior IV therapies at hospital

• Chemo unit and beds at capacity

• National targets at risk (££ fines)

• Hospital costs 8-10X higher

PREVIOUSLY THE SITUATION WAS SUBOPTIMAL FOR ALL STAKEHOLDERS

• NHS “QIPP” program (2012--)

• Seeking ~£20 billion in savings

• Difficult to achieve!

PATIENT HOSPITAL NHS

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A REDESIGNED, PATIENT-CENTRIC SERVICE AIMED FOR “BETTER CARE, CLOSER TO HOME”

• Patient choice: hospital, local clinic or home injection via

mobile nurses

• Hospital efficiency: outpatient pharmacy to supply drugs

for home administration; reinvest cost savings in

innovation

• Safety first: focus on patient safety-health with ongoing

physician/nurse guidance

• Integrated approach: clinical governance and protocols

for check-ups, tests, etc.

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• Cancer and bone complications

under control

• Best therapy, convenient setting

• Saving time and ££ each month

• Freed-up capacity to treat

patients per national guidelines

• Reinvesting cost savings

• 100% patient satisfaction!

TODAY THE SITUATION IS DRAMATICALLY IMPROVED FOR ALL CONCERNED

• Proof: QIPP can work well

• Lower overall costs

• 100% patient (voter) satisfaction!

PATIENT WIN !! HOSPITAL WIN !! NHS WIN !!

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• Clatterbridge/Amgen partnership

recognized as best practice

• 2015 National Pharmacy Mgmt. Forum

(NHS payer conference) award:

“Best Industry/NHS Partnership” --

Dept. of Health, NHS England now

working to replicate this program

• 2016 EU “Health Collaboration Award”

THE VALUE OF THIS PARTNERSHIP HAS BEEN RECOGNIZED AT UK AND EU LEVELS

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TO BE SUCCESSFUL WITH VBHC, WE NEED ALL HEALTHSYSTEM STAKEHOLDERS TO ENGAGE AND COMMIT

Payers:

Evidence-based

reimbursement;

pay for outcomes

Policymakers:

Outcomes-based

HC systems

Providers:

Evidence-based

medicine

Patients:

Agree to share

data

Commit to

a new

approach

Demonstrate value

Focus on patient

outcomes

Proactively engage

stakeholders

Optimize the product

life-cycle

Industry

€

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THANK YOU

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