Medical Services

Pharmacists’ Integration Into Value-Based Care

As value-based care continues to evolve, specialty pharmacies have an opportunity to create sustained value across the health system.

Specialty pharmacists have leveraged a comprehensive framework for driving value called the 5 imperatives:

  • Engaging patients.
  • Designing solutions to improve health outcomes.
  • Integrating learning teams.
  • Measuring health outcomes and costs.
  • Expanding partnerships.

Investing in Your Patients

Value-based care focuses on reducing costs and improving quality. Physicians, providers and health systems must all participate in a comprehensive set of steps that can lead to this transformation.

Patients are an essential part of this process. They stand to gain the most from the switch to a value-based care model.

Pharmacists can help physicians meet the requirements of these models by enhancing medication management and preventing adverse drug events that result in emergency room visits. This work can also improve patient adherence, which can help reduce hospitalizations and costs.

These efforts may involve providing medication reviews, helping patients understand their medications and guiding them through drug-drug interactions. It also includes educating patients on healthy lifestyle habits and promoting preventative care.

Another way that pharmacists can enhance care is by assisting in transitions of care, such as those from hospital to community. This can help patients avoid hospitalizations and keep them from relapsing into old behaviors like smoking.

Finally, pharmacists can help improve population health by partnering with health systems to provide services such as pharmacy-delivered immunizations, virtual-based medication management and adherence support. These programs expand access to care, reduce E.D. use and increase adherence and overall patient satisfaction.

A system-wide infrastructure that supports standardized pharmacy-level quality metrics, performance goals and patient outcomes is critical to successfully transforming value based care pharmacy. This infrastructure must be secure, transparent and interoperable to ensure the efficient and effective use of pharmacy resources and improve patient outcomes.

Investing in Technology

When integrating pharmacies into value-based care, technology can be critical. This is especially true in the broader healthcare industry, where technological innovations are increasingly central to improving quality, productivity and profitability.

Like any other business, technology companies must demonstrate that they have developed a business model that will provide a sustainable competitive advantage for their customers and a sound financial plan. They must also show how their technology will help them deliver on this plan.

Investing in the right technology can help pharmacists work effectively with healthcare organizations and insurance providers to achieve patient outcomes. This will help ensure that pharmacists can offer patients the best possible care and that their organizations can achieve cost savings through improved patient outcomes.

This technology should provide an accurate picture of the status of pharmacy operations, including how many medications are on hand at any given time, whether any prescriptions are on hold, and which ones are being sent back to the manufacturer. This information can be used to identify opportunities for improvement and can also provide a basis for contracting with payers.

This type of system-wide infrastructure is already in use by Medicare, but there are opportunities to expand its scope beyond Medicare and into other insurance lines of business, such as Medicaid and commercial. This would require a secure, transparent and interoperable system that can support pharmacists’ efforts to meet quality metrics, their performance goals and patient outcomes.

Investing in Education

Investing in education can open doors to higher-paying jobs or increase the potential for a family to have children who attend school until college. It can also help people to live better lives and contribute more positively to their communities.

Preparing for new opportunities and challenges is essential in a constantly changing world. Educating yourself and your colleagues can give you the tools you need to adapt quickly to changes in the healthcare industry.

While many pharmacists believe that integrating into value-based care is not the easiest, hard work and dedication make it possible. By partnering with payers and health plans, developing relationships with community pharmacies and engaging in consistent advocacy within pharmacy organizations and professional associations, pharmacists can help drive value-based care in the U.S.

A well-designed infrastructure for enabling value-based pharmacist-provided care and enhancing collaboration with health plans, insurance companies and payers exists. It focuses on industry-endorsed quality metrics, performance goals and patient outcomes and aims to align pharmacists’ needs with those of their payer partners.

This model provides opportunities for sustainable partnerships that strengthen revenue streams and diversify the portfolio of services offered by pharmacy organizations in the healthcare market. These partnerships can be supported by fee-for-service arrangements or pay-for-performance contracts.

Investing in Yourself

With a growing number of value-based care models in the healthcare system, pharmacy teams need to be prepared to support this shift. They can help patients navigate the process and ensure physicians practicing value-based care trust that pharmacist-provided care plans result in the best possible patient outcomes.

Pharmacists are positioned to play a pivotal role in patient-centered care and value-based healthcare through collaboration with other healthcare providers, payers and pharmaceutical drug manufacturers. These partnerships promote value by uniting patient touchpoints in a fragmented healthcare system and driving positive patient outcomes.

A significant opportunity for specialty pharmacies lies in promoting value across the healthcare continuum, from prevention to treatment to management of complex conditions. This includes coordinating care across various stakeholders – including patients, caregivers, prescribers and payers – to improve quality, scale operations, and reduce complexity in the healthcare system.

In addition to partnering with existing healthcare stakeholders, specialties seek to build relationships in new areas of the industry and expand their reach. These connections can foster a more holistic understanding of patients’ needs and experiences, increase patient engagement, improve access and facilitate communication throughout the healthcare journey.

One of the most pressing issues facing community pharmacies is the involvement of Pharmacy Benefit Managers (PBMs). These PBMs have influenced the current structure of outpatient community pharmacies and contributed to many problems. While this has impacted pharmacists’ ability to provide clinical services and their profit margins, several collaborative payment models have been proposed that could offer solutions to these challenges.