June 19, 2015 – Curant Health COO, Marc O’Connor, in Specialty Pharmacy Times – There is no question that one of the changes brought about by the ACA is increased scrutiny of healthcare insurance plans by consumers and employers alike.
New regulations, economic pressures and patient expectations are changing healthcare in US overall plan quality. A close examination of costs, medication adherence and associated patient value are top considerations in payer plan development and consumer plan choice.
Given the increasingly loud drumbeat in protest of rising plan costs and the closing of quality gaps demanded by CMS for stakeholders participating in government-run programs, payers should tap all available healthcare stakeholder resources, including pharmacists, to ensure plan value.
Here are three 3 high value-based attributes payers should be seeking from pharmacist partners.
1. A shared view on the definition of healthcare value
Recently, there has been increased buzz about narrowing payer networks. I think this focus is misplaced, and I am confident the discussion should be focused on improving network quality. It then follows that the next logical questions are how to define both network quality and health care value.
The health care value quotient can be measured by the simple equation of outcomes divided by costs. Health care value and associated plan quality must take into account opportunities to impact both the numerator: improve patient outcomes, and the denominator: reduce costs in this model.
A sole focus on cost reduction disproportionately discounts the overall value-increasing benefits from improved patient outcomes. No value is realized when the outcomes numerator decreases in parallel with a decrease in the costs denominator. And yet there is widespread dissatisfaction with the value being received from health care services. The discussion among stakeholders, including payers and partner pharmacists, must shift to improving patient outcomes within current health care spending constraints. A shared view of healthcare value facilitates focus on improving plan quality.
To read Marc’s full article, visit Specialty Pharmacy Times.
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