Competing on outcomes happens at a system level. Increasingly, it’s becoming a ‘winner-take-all’ game.

In the RFPs for Netflix subscription models to pay for hepatitis C drugs, states of Washington and Louisana are both looking for the winning bid to include support and education for their prison populations.

Which opens space for value innovation in “correctional health care.” This is a subsystem of markets comprised of outsourced, for-profit contracts for about 70 percent of prison care in the United States. The two largest providers of prison health — CorizonHealth and Wellpath — are responsible for the care of about 400,000 people on a day-to-day basis.

Can Gilead Sciences, AbbVie or Merck apply what they know about discharge planning to reduce rates of reincarceration? Can that social impact be used as an outcome measure to differentiate beyond drug price?

PhRMA was once a heroic industry, doing miracles with science. With some strategic imagination, and a re-allocation of resources and mindset, it still can be.