As health insurance companies replace fee-for-service payments with bundled and outcomes-based payments, they are turning to pharmaceutical companies as partners in their efforts to lower costs and improve outcomes.

Mutual interest and complimentary expertise drives payer-pharma alliances. From an economic perspective, both organizations want and need to improve profits by increasing efficiencies and trimming waste, regardless of whether the particular focus is healthcare delivery, in the case of the payer, or drug development, in the case of the pharma company. From a clinical and humanistic perspective, both organizations share a vision of improved quality of care with lowered costs.

At least two agreements between payers and pharma formed long enough ago to report preliminary outcomes. In 2011, healthcare payer WellPoint’s analytics division, HealthCore, formed a collaboration with AstraZeneca, and the insurance company Humana formed a partnership with Pfizer. While the agreements between the partners differ in specifics, they share three commonalities: a focus on trust, an agreement to share risk, and a shared vision of what healthcare truly could be.

In addition to partnering to advance their mutual interests, the organizations are leveraging each other’s complimentary expertise to achieve the shared goals of improved healthcare delivery and creation of greater value.

AstraZeneca brings to the partnership with HealthCore knowledge of therapeutics and disease states related to areas in which they are pursuing innovative products, says Marcus Wilson, president of HealthCore. The “surprise” to HealthCore was AstraZeneca’s understanding of healthcare delivery and specifically healthcare information technology, and how that plays into an understanding of how to view the patient.

On the flip side, HealthCore brings a vision of how to move forward, says Brian Sweet, AstraZeneca’s executive director, US Payer & Real World Evidence. In order to get to the “promised land of improving outcomes and reducing total cost of care,” says Sweet, “we had to take a deep dive” into the healthcare community to develop a richer view of patients. “This goes beyond big data, we need to have deep data to answer the evidence questions being asked,” he says. HealthCore brings that to the table with its collaborations with other stakeholders, including local and state governments.

The collaboration between HealthCore and AstraZeneca, termed the “real world evidence health collaborative” is broad in terms of disease focus. It is assessing care delivery data, treatment impact on hospital length of stay, readmissions, overall health status, cost of care, and other key evidence-based outcomes, and is seeing real outcomes.

The greatest value and outcome to date, possibly, is the understanding the partners have developed of how to integrate data from multiple sources in a way that allows for evidence development in advance of generating new models of healthcare delivery and payment. Moving forward to understand the deep data has been a challenge. Already a champion of big data, for HealthCore there was still the need to overcome a “learning curve for integrating data so that it is usable for evidence development,” says Wilson.

For drug developers, integrated data delivers a much richer ability to not only assess outcomes but also to identify the right patient populations for clinical trials or expanded use studies. “It’s been an eye opener to see how complex integrating various data types is and how expensive it can be,” says AstraZeneca’s Sweet. “We expected it to be difficult but had no idea how complex it is.”

The collaborations and partnerships also take post-marketing studies to an entirely new level. In both partnerships formed in 2011, the parties are directing resources to not only synthesize actionable information from rich and complex patient data collected from multiple sources, but also to advance clinical trials, increase the market share, and, in the case of AstraZeneca, gain valuable insights into future drug development and business opportunities.

AstraZeneca and HealthCore have two dozen abstracts, presentations, and one peer-reviewed manuscript published on results from their collaboration, on studies ranging from the “Capture rate of electronically available laboratory test results in the HealthCore integrated research database,” and “Establishing a weighting methodology to compute the number of patients with disease using claims data and census population in the United States” to “A real-world U.S. retrospective database analysis evaluating treatment patterns, healthcare resource utilization and costs in patients with bipolar disorder.”

While payers are using their databases to generate new models of healthcare delivery that will ultimately save them money, their pharma partners are seeing returns as well. AstraZeneca has utilized the database to build endpoints into their studies of products in development so those marketable endpoints make it into the label or marketing literature, and to perform studies on existing products to differentiate them from competitors and show payers there is place in the market for their product, either by providing evidence on an additional niche or on reducing hospital costs or improving quality of life. They’ve even used the database to evaluate new business development opportunities for purchasing compounds and a company.

The arrangement reflects the growing need of healthcare decision-makers to determine clinical and cost effectiveness using comparative effectiveness research and “real-world” analyses. Unlike clinical trials, which are very controlled, especially in terms of patient compliance, real-world evidence takes into account observational data that includes electronic medical records, claims information, and patient surveys.

Similarly, insurance provider Humana partnered with Pfizer to advance the goal of returning real-world information on adherence, adverse side effects, and disease incidence prevalence back into the drug discovery process. Ultimately better medicines with improved patient compliance and health outcomes will churn out the other end of the iterative process. To make this happen, Humana needed a “willing participant with the same view,” says William Fleming, president of Humana Pharmacy Solutions. The collaboration will get Humana to their goal faster than taking “a piecemeal approach on its own” to improve care quality and lower costs, says Fleming.

The partnership is focused on three chronic conditions-pain, cardiovascular disease, and Alzheimer’s disease. And while “we haven’t had an aha moment yet,” says Fleming, “a strong relationship has formed to find that aha moment, to find ideas to improve outcomes and lower costs.” While perhaps not the exciting result one might hope for, an unexpected outcome of the dive into data for Humana was that an assessment of the complex and deep dataset for chronic pain patients led to a predictive model of what type of patient is at risk for opiod abuse. This insight will allow Humana to identify those patients earlier and intervene, saving money. The benefit for Pfizer is fewer adverse reactions and better marketability of its drugs, improving profits.

Two additional partnerships and one more collaboration have been announced since 2011. Humana has separate agreements with Boehringer Ingelheim and Eli Lilly, and Geisinger Health Systems has an agreement with German company Indivumed.

Research partnerships with payers help pharma companies address concerns and build trust with those normally at the opposite side of the table. With their ability to collaborate with multiple stakeholders, including municipalities and state governments, payers add tremendous amounts of complex data that pharma companies can bring to their clinical development programs that are increasingly geared toward not just regulatory approval, but reimbursement too. These new-found relationships between payers and pharmaceutical companies are bound to increase as payers exert greater influence on clinical trial design and, should a drug be approved, have growing impact on the market success or failure of a drug.