“Value-based care programs need to leverage every available strategy to address the greatest challenges facing our healthcare system – the unsustainable escalation of costs and the fragmented nature of care,” said Marv Feldman, RPh, MS, managing principal, Pharmacy Consulting Program, Premier, who was one of the authors of the article. “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.
“This framework provides guidance for providers who are working to implement value-based programs that achieve broader quality and cost reduction goals,” said Donald W. Fisher, PhD, CAE, AMGA president and chief executive officer.
“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,” he said.