Healthcare Matters

As health care providers move to establish ACOs and decipher the calculus that defines “value-based care,” the National Pharmaceutical Council (NPC), the American Medical Group Association (AMGA) and Premier have teamed with seven provider organizations to develop a framework considerate of the role played by pharmaceuticals in achieving value-based success. Aptly named, the team calls itself the “Working Group on Optimizing Medication Therapy in Value-Based Healthcare.”

Providers are shifting to value-based care models and many of these models, such as the CMS Shared Savings Program, include quality benchmarks and incentives for reducing costs. “As providers evaluate optimal care for their patient populations in these new models, prescription medications should be thoughtfully integrated into the process,” said NPC Chief Science Officer Robert Dubois, MD, PhD. “It is crucial for ACOs to view prescription drugs as a tool, not simply an expense,” Dubois said. “When medications are appropriately used, they can contribute significantly to improving patient outcomes and reducing overall costs.”

“Value-based care programs need to leverage every available strategy to address the greatest challenges facing our health care system – the unsustainable escalation of costs and the fragmented nature of care,” said Marv Feldman, RPh, MS, managing principal, Pharmacy Consulting Program, Premier. “Medications are important assets in helping providers achieve these objectives.”

The value-based framework developed by the Working Group includes the following elements:

• Success in a value-based environment will depend on understanding the unique contribution of medications and utilizing them optimally across conditions and populations.
• Medications cannot be viewed as a siloed expense item in a value-based environment. They need to be integrated so that the cost offsets and quality benefits resulting from optimized pharmaceutical use can be recognized and calculated.
• Services meant to optimize patient outcomes cannot be undertaken as a one-size-fits-all approach; the role, impact and characteristics of these services will vary by a patient’s condition.
• Overall risk factors can be used to identify patients who are candidates for medication therapy management strategies to watch for drug-drug, drug-disease, or polypharmacy concerns.
• In each circumstance where there are condition-specific incentives to achieve cost savings, there should also be a quality metric to detect under-use of pharmaceuticals.

“As providers navigate this new landscape, they can rely on this road map to optimize medication therapy and ensure patients have access to, and support in using, the medications they need,” said Donald W. Fisher, PhD, CAE, AMGA president and CEO.

Source: PR Newswire

—Tom Finn