What is the VITAL program?
VITAL leverages claims-level and clinical data to produce evidence for commercially available products (devices, tests, and processes) that have not been widely adopted. The VITAL team designs targeted, accelerated, real-word tests to gathers integrated clinical, medical cost, and patient experience data. Collaborators then evaluate the products’ clinical and cost-effectiveness and make recommendations for market adoption.
Why was the VITAL program created?
Highmark Health designed the VITAL program to provide creative care delivery solutions for physicians in a highly competitive western Pennsylvania market. Since its launch in 2015, the VITAL program has been fostering collaboration to advance innovation:
- Clinicians are rewarded for proposing ideas and funding to solve key issues.
- Eligible members of a Pennsylvania health plan gain earlier access to promising new treatment options with proven outcomes.
- The Pennsylvania health plan gains medical policy efficiencies and cost savings as new care solutions are adopted.
How is the VITAL program structured?
Highmark Health developed VITAL to leverage the unique capabilities, data, and expertise of Allegheny Health Network clinicians and a large Pennsylvania health plan.
Highmark Health Role
Highmark Health funds the VITAL program and provides the analytics to support VITAL’s research studies. It also identifies eligible members for studies. Under the Highmark Health umbrella, the VITAL team aggregates, analyzes, and packages test results for its collaborators.
Allegheny Health Network Role
Allegheny Health Network (AHN) clinicians develop proposals for candidate solutions based on identified needs. Because all VITAL projects require a physician sponsor, AHN clinicians also participate in testing and gathering data in areas that match with their expertise.
Large Pennsylvania Health Plan Role
The participating Pennsylvania health plan is a “customer” of the VITAL program. It oversees VITAL’s solution selection process and the prioritization of projects. It also manages the claims data required to measure cost-efficiency. And it helps inform VITAL’s health-plan-focused evidence outputs.
How long are VITAL tests?
The typical evaluation processes takes 6 – 18 months, depending on the quality of evidence available for review prior to test launch. The VITAL team evaluates new solutions and conducts tests in parallel as capacity allows.
Who is the VITAL team?
The VITAL team is made up of data scientists, clinical researchers, and business development leads who are experts in analytics and program management.
Who conducts clinical research for VITAL?
VITAL is connected with more than 2,800 Allegheny Health Network (AHN) clinicians across 8 hospitals, plus independent physicians in western Pennsylvania. We either invite certain experts to participate in our tests or they volunteer. Oftentimes, experts from the AHN Research Institute participate in our research programs. They specialize in more than 120 areas of medicine.
What quality controls are in place to ensure the credibility of study results?
Before we launch at test, the VITAL team thoroughly vets candidates for the program through a Landscape Assessment and Solution Impact Assessment processes. We select only those solutions most likely to produce positive results. We monitor key performance indicators to ensure projects are scaled, adjusted, or curtailed as appropriate.
What types of solutions are tested?
The VITAL team evaluates health care technologies, labs, and/or processes that are commercially available and have received FDA approval — or other certification equivalents (e.g., CLIA certification for labs) — but have not yet received coverage under most health plan medical policies. We prioritize candidates based on how a company’s needs match with our capabilities. We currently do not test pharmaceutical therapies.
What are VITAL's clinical focus areas?
Our clinical focus areas currently include oncology, women’s services, cardiac care, diabetes, chronic obstructive pulmonary disease (COPD), precision medicine, and digital therapeutics. We may consider other areas on a case-by-case basis.
What is the size of the member population available for VITAL studies?
VITAL tests currently draw on data from more than 5 million health plan members.
What has VITAL tested so far and what is currently in the VITAL program's pipeline?
As of January 2018, more than 40 new ideas were under evaluation or under development. Additional growth is expected as our program continues to scale. By 2020, the team hopes to manage more than 10 innovation projects annually.
Can vendors influence the VITAL program's evidence outputs?
VITAL is committed to preserving objective and transparent processes. As such, the VITAL team will disseminate all relevant test results to health plan constituents regardless of whether they are positive, negative, or inconclusive. Vendors will not be allowed to prevent or influence test outcome distribution.
Can my local AMC partner participate in VITAL studies?
At this time, only certain providers may execute VITAL tests. We are currently exploring opportunities to coordinate and scale tests across health plan geographies, however.
Could VITAL's evidence outputs be leveraged to support a negative medical policy determination?
VITAL’s main goal is to support the improvement of health care delivery. We decide to test solutions that are likely to deliver positive health and patient experience outcomes at competitive costs.
VITAL is also committed to its role as an objective, transparent, source for evidence. Therefore, we will disseminate positive, negative, and inconclusive outcomes for all evaluated solutions. Health plans retain full discretion over whether and how to apply findings internally. In some cases, test results may be used to support a plan’s rationale for excluding a solution from coverage.