Performance-based risk-sharing agreements in renal care: current experience and future prospects

Michael Drummonda Centre for Health Economics, University of York, York, UK;b Center for Research in Health and Social Care, Bocconi University, Milan, ItalyCorrespondence[email protected]

https://orcid.org/0000-0002-6968-4610 View further author information

Carlo Federicib Center for Research in Health and Social Care, Bocconi University, Milan, ItalyView further author information

Ellen Businkc Health Economics and Market Access EMEA, Fresenius Medical Care, Bad Homburg, GermanyView further author information

Christian Apelc Health Economics and Market Access EMEA, Fresenius Medical Care, Bad Homburg, GermanyView further author information

Dana Kendziac Health Economics and Market Access EMEA, Fresenius Medical Care, Bad Homburg, GermanyView further author information

Werner Brouwerd Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands

https://orcid.org/0000-0002-0476-8397 View further author information

ABSTRACT

Introduction

Performance-based risk-sharing agreements (PBRSAs), between payers, health care providers, and technology manufacturers can be useful when there is uncertainty about the (cost-) effectiveness of a new technology or service. However, they can be challenging to design and implement.

Areas covered

A total of 18 performance-based agreements were identified through a literature review. All but two of the agreements identified were pay-for-performance schemes, agreed between providers and payers at the national level. No examples were found of agreements between health care providers and manufacturers at the local level. The potential for these local agreements was illustrated by hypothetical case studies of water quality management and an integrated chronic kidney disease program.

Expert opinion

Performance-based risk-sharing agreements can work to the advantage of patients, health care providers, payers, and technology manufacturers, particularly if they facilitate the introduction of technologies or systems of care that might not have been introduced otherwise. However, the design, conduct, and implementation of PBRSAs in renal care pose a number of challenges. Efforts should be made to overcome these challenges so that more renal care patients can benefit from technological advances and new models of care.

KEYWORDS:

Article highlights

Performance-based risk-sharing agreements are attracting considerable interest in health care, as they offer potential benefits to patients, technology manufacturers, health care providers and payers.
Despite this interest, progress in establishing these agreements has been slow and has been mainly limited to new medicines.
The field of renal care is a potential candidate for these agreements, since it consists of a range of expensive long-term services, the quality or cost-effectiveness of which could be improved.
This paper adds to our knowledge by identifying a number of such agreements in renal care, describing their key characteristics.
Performance-based risk-sharing agreements can be complex in the field of renal care, requiring agreement by payers, providers and technology manufacturers on a number of key issues in the design, conduct and evaluation of schemes.
These complexities are illustrated by the use of two hypothetical case studies.
Overall, there is further scope for PBRSA in renal care, providing the main challenges can be overcome.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Declaration of interest

Ellen Busink, Christian Apel, and Dana Kendzia are employees of Fresenius Medical Care. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.