The enduring value of HEOR for payers

The value of Health Economics and Outcomes Research (HEOR) is not always clear, as outlined in a series of articles in a recent issue of the Value & Outcomes Spotlight , a journal for the global HEOR community produced by ISPOR, the leading professional society for HEOR. In the featured article, “Making the Impact of HEOR Loud and Clear ,” the authors describe changes in the organization of HEOR teams within biopharmaceutical companies that appear at odds with the high and unrelenting demand for the types of insights that HEOR provides and ask readers to “tell stories of innovation and impact” that positively affect healthcare decisions.

HEOR remains a fundamental component in the evaluation of healthcare interventions, such as drugs and medical devices. This multidisciplinary field examines the clinical, humanistic, and economic outcomes in healthcare, offering insights necessary for stakeholders across the spectrum. Despite shifts in organizational structures within the industry, the value of HEOR persists, particularly for healthcare payers.

The rise of expensive yet effective treatments has increased the demand for HEOR to estimate treatment value accurately and to aid healthcare payers in making informed decisions about access and reimbursement. HEOR also addresses the complexity of healthcare delivery by offering a comprehensive understanding of how interventions affect populations economically and clinically. This role remains crucial as the healthcare landscape continues to evolve.

Examples of HEOR's enduring value are evident in diverse studies by Carelon Research that address significant and timely healthcare challenges.

One study  examined the impact and costs of various treatments for depression in the U.S., highlighting that "no treatment" is more costly than any form of treatment. Using claims data of individuals newly diagnosed with major depressive disorder, it was found that 34% received medication, 25% psychotherapy, 28% both, and 13% no treatment. Patients with combined treatments showed symptom improvement, while untreated patients incurred the highest healthcare usage and costs.

This study suggests that improving access to psychotherapy, via telehealth for example, and integrating behavioral health into primary care could enhance patient outcomes.

Another study  explored the prevalence of health-related social needs among commercially insured members in Georgia and Indiana. By integrating survey data with medical claims, the study uncovered a strong correlation between unmet social needs — such as lack of healthcare access, inadequate social support, and financial instability — and poor health outcomes, including increased anxiety, depression, and hypertension.

These findings advocate for comprehensive screenings of all health plan members to better address these critical issues, reinforcing the necessity of addressing social drivers in healthcare.

Additionally, research into breast cancer screening disparities  revealed significant gaps in screening rates based on socio-economic status and geographic location. With an average 38% non-screening rate among commercially insured women, the study identified areas, particularly in California and the western U.S., where non-screening rates exceeded 50%.

This underscores the necessity for targeted outreach and awareness programs to encourage mammography in underserved areas, leveraging healthcare provider consultations as pivotal intervention points.

Together, these studies not only inform policy and practice, but also highlight the vital role of HEOR in addressing current healthcare challenges. By providing evidence-based insights, HEOR continues to guide policymakers, payers, and providers in enhancing healthcare quality, ensuring equitable access to interventions, and offering solutions that align with the evolving healthcare landscape. These "stories of innovation and impact" highlight HEOR's value in informing and improving healthcare outcomes for diverse populations.

Ultimately, the consistent demand for HEOR from payers demonstrates the field's ongoing relevance. With countless examples of real-world impact, HEOR continues to be of enduring value, enabling payers to make informed, evidence-based decisions in a constantly changing world.

Carelon Research has more than 25 years of experience conducting HEOR. By leveraging real-world data from the Healthcare Integrated Research Database (HIRD®), we provide stakeholders, including life sciences companies, government agencies, and Elevance Health, with evidence to inform complex healthcare decisions.