Risk Sharing Agreements As Payment Mechanisms: A Comprehensive And Communicable Practical Approach For Stakeholders

OBJECTIVES: Many stakeholders are not familiar with the scope of risk sharing agreements (RSA) as payment mechanisms (PM) yet. As part of an academic research and with the aim to socialize the structure, dimensions and main components of RSAs among stakeholders involved in this issue, a scoping review was conducted and many key aspects were unified in a unique evidence-based RSA-PM comprehensive and communicable practical approach for stakeholders. RESULTS: After the examination of 48 references, an approach gathering sequential and logical aspects of RSA-PM was developed. The proposal covers not only performance aspects but also PM features in an appealing and communicable way. In the first place, it considers the strategic and active confluence of key stakeholders (payer, manufacturer, clinicians, patients and neutral entities). It considers the provision of a normative dimension detailing in full three main sub-dimensions: design, implementation and assessment of the RSA-PM. Each phase comprises exhaustive components intended to communicate and clarify critical aspects to focus on, e.g.: for the design phase, the main components stakeholders should focus on are negotiation parameters and health contracting. Health contracting should define the objective of adopting a RSA, pricing and reimbursement scheme, information technologies required, types of information produced and data access, responsibilities, outcomes agreed, patient-access norms (eligibility criteria), among others. In the case of implementation and assessment, the framework suggests clinicians', manufacturer's, payer's and neutral entities' key activities. CONCLUSIONS: The approach is the product of a scoping review that proved that RSAs should emphasize the entire architecture of PM. A comprehensive representation was achieved and used in three different projects, demonstrating to be useful to successfully communicate the structure, dimensions and main components of a RSA-PM to technical and non-technical stakeholders unfamiliar with the scope of RSA-PM. This approach is highly recommended as a tool for the communication of RSA-PM.