The year 2020 will see both new opportunities and continued challenges in managed care pharmacy. Technologies will play a major role in enhancing administrative processes while treatments will continue to become more advanced, to name a few.
Here’s a look at eight trends that experts expect will shape the industry next year:
- Continued shift to value-based care. Thomas R. Bizzaro, RPh, vice president, Health Policy and Industry Relations, FDB (First Databank, Inc.), a San Francisco-based company focused on providing trusted medical knowledge, expects to see an ongoing move in managed care pharmacy from fee for service to value-based care in 2020, with an expanded focus on quality of care and outcomes. “There’s no longer a controversy about whether the industry is moving away from fee for service—the question now is how fast the move to value-based care is going to happen,” he says.
In this emerging environment, Bizzaro says payers and providers will work even more closely together, with shared responsibility for outcomes and shared risk and rewards tied to the cost of care. Meanwhile, CMS and private insurers will continue to expand these payment models to areas that traditionally weren’t covered to improve outcomes. There will be a growing focus on educating members to improve their understanding of their medication therapy (i.e., why they’re taking a drug, when they need to take it, and possible side effects). “This knowledge will ultimately improve adherence,” he says.
- Increased integration of medical and pharmacy benefits. Historically, medical, and pharmacy benefits have been siloed. When employers and other organizations design benefit plans, they typically use one company for medical benefits and a different one for pharmacy benefits. Because the companies are separate entities, they don’t share data or information. Therefore, there’s a disconnect.
“As a result, plan sponsors are challenged to ensure that members receive coordinated care and understand the true cost of care,” says Jerry Buller, DPh, MMHC, chief pharmacy officer at Trellis Rx, a specialty pharmacy located in Atlanta that partners with health systems to enhance patient experiences. “These issues are particularly relevant for patients with chronic and complex conditions, who often require high-cost specialty medications. A plan sponsor and medical team may miss important opportunities to comprehensively manage a patient’s care.”
Moving into 2020 and beyond, Buller believes plan sponsors will begin demanding solutions that address these siloes. Today, UnitedHealthcare’s Optum has programs that provide insight into both medical and pharmacy benefits. Other companies are attempting to replicate this via mergers and acquisitions. Finally, more integrated delivery networks are now offering comprehensive health plans as a solution to these challenges.