In healthcare, time is of the essence. According to Highmark Health, it currently takes 20 to 25 years to bring a new therapy to patients within a healthcare system—a delay that is costly and unsustainable.
To address that issue, the Pittsburgh-based Highmark has created VITAL, a program designed to accelerate the adoption of new technologies that have received regulatory approval but are not yet covered by most commercial insurance companies.
“Technologies that have received regulatory approval from the FDA often lack sufficient scientific data to convince commercial insurers to pay for them,” the company says. “Without support from commercial payers, it is difficult for new innovations to influence the practice of medicine.”
Highmark Health wants to influence this process through its position as the country’s third-largest integrated healthcare delivery and financing system. It describes VITAL as “the missing link between FDA approval of an innovative technology and its full reimbursement.”
Highmark Health outlined the following program goals as:
- Affording patients access to safe new technologies without undue financial burden
- Obtaining information on the impact of new technologies to inform insurance medical policy decisions
- Providing clinicians early access to novel technologies
- Providing vendors the opportunity to prove the benefits of their innovations to patients, providers, and payers.
The program encourages clinicians from Highmark Health’s Allegheny Health Network to collaborate with outside technology vendors, providers, partners from nonprofits, and government agencies to submit proposals to the VITAL Review Board. Proposals are requested to identify knowledge gaps and outline a pilot project or clinical trial designed to fill those gaps.
The company says submissions are accepted at any time and the review board may provide feedback and work with applicants on feedback implementation and presentations. If selected, “The Office of the Chief Innovation Officer at AHN will work with the established teams of innovators to craft their work plans and study design to yield actionable results,” the company says.
Factors in the decision include the quality of scientific evidence for the technology, its ability to impact a large number of patients, and its ability to reduce total cost and provide a return on investment.
Highmark Health has so far funded proposals to evaluate three medical devices, and has four or five more in the pipeline, Alan Russell, Ph.D., chief innovation officer of Allegheny Health Network, recently told Health Plan Week.
Two of the three funded proposals have been made public. They include Freespira Breathing System by Palo Alto Health Sciences, which aims to help people control their breathing during panic attacks; and LINX Reflux Management System by Torax Medical Inc., which treats acid reflux disease.
The third technology, being tested in collaboration with Boston Scientific Corporation, has not yet been announced.