Pharmacists critical to success in 5 value-based models
At AMCP 2016, presenters identified five types of alternative payment models, and shared why pharmacists play a key role.
Michael Ellis, chief executive officer, Maxor National Pharmacy Services, and Fauzea Hussain, senior vice president, Avalere Health, delivered a conversational discussion on “Dimensions of Managing Specialty Drugs in Current and Evolving Alternative Payment Models” at the Academy of Managed Care & Specialty Pharmacy Annual Meeting 2016.
The presentation, held Wednesday April 20, outlined the paradigm shift in healthcare from volume to value, and highlighted a variety of alternative payment models. “Pharmacists will play a central role in this care payment and delivery shift,” Hussain said.
Hussain
“Alternative payments models have begun to transform healthcare payment into a ‘medical neighborhood’ and target specialty drugs for utilization management due to projected spend,” she said.
Hussain described unprecedented goals by the private and public sectors in migrating toward alternative payment models (APMs), including commitments by the Department of Health and Human Services to shift half of all Medicare fee-for-service payments to APMs and increase fee-for-service payments linked to value by 90% by 2018.
In addition, members of the Health Care Transformation Task Force, a group of providers, payers, purchasers and others, have committed to putting 75% of their business in APMs by 2020.
The pharmacist’s role in ACOs, PCMHs, and bundled models
The speakers outlined five key public sector APMs incentivizing care delivery changes: accountable care organizations (ACOs), patient-centered medical homes (PCMHs), bundled payments, medication therapy management (MTM) and value-based insurance design (VBID).
They recounted the goals of the first three models: improving quality while reducing spending; enabling the provision of comprehensive care; and maximizing efficiency within a bundle of care, respectively.
Hussain said there is an opportunity for pharmacist involvement in ACOs by quantifying medication offsets, notifying care providers when prescriptions are filled, implementing protocols to eliminate duplicate medications/polypharmacy and by participating in direct patient care.
PCMHs could engage pharmacists in medication synchronization, adherence and therapy management, she said. However, 66% of providers do not have pharmacy partners within their networks, according to the Pharmacy Benefit Management Institute.
Hussain said pharmacists could help drive the use of the highest value drugs in a bundled payment model, which is exploring coverage of cross provider services, such as those offered by hospitals and physicians for an episode of care.
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