Interested in sharing the research? You can order print copies of many research publications.

Order Reprints

Newsletter Sign-Up

Keep up to date with NPC news and events by signing up for our e-newsletter E.V.I.dently, and our CER Daily Newsfeed.

Subscribe POLICY

Role of Pharmaceuticals in Value-Based Healthcare: A Framework for Success

Accountable Care Organizations (ACOs) have received a great deal of attention and press through peer-reviewed articles and news stories, and new efforts are underway to develop tools needed to be a successful ACO. Success in an ACO world is different from success in a capitated environment, where the focus is only on managing costs. In an ACO, providers have at least some financial responsibility and they are also accountable for the quality of care they provide.  How does an ACO succeed in this environment of dual responsibility for costs and quality? How do pharmaceuticals fit in?

This research addresses these questions through the development of a conceptual framework for considering the role of pharmaceuticals in ACOs, including a condition-specific grid that lays out the cost and quality impact pharmaceuticals may have on each condition. If done correctly, value-based health care can enable patients to gain access to, and support in using, needed medications, and can do so while simultaneously lowering cost growth and achieving the quality benchmarks that the marketplace will soon demand.

The research also finds that:

  • 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. 
  • Medication therapy management (MTM) cannot be undertaken as a one-size-fits-all approach. The role, impact and characteristics of MTM will vary by condition.
  • Composite risk can be used to identify patients who are candidates for MTM strategies to watch for drug-drug, drug-disease, or polypharmacy concerns.
  • In each circumstance where there are condition-specific incentives to achieve economic savings, there should also be a quality metric to detect under-use of pharmaceuticals.
Newsletter Volume

E.V.I.dently: April 2016

MessageValue Assessment Through a Broader, Patient-Focused LensNPC has developed “Guiding Practices for Patient-Centered Value Assessment” to help...
Blog Post

Bundled Payments: Opportunities and Challenges

As use of bundled payments increases, how do health system stakeholders minimize the risk of unintended consequences and maximize chances this...
Blog Post

NQF’s Annual Conference Drives Conversation Around Quality Measures, Value-Based Care

As the health care system moves toward one emphasizing the value of care over the volume of care, quality measures play a key role in this shift to...
Blog Post

NPC’s Dr. Dubois Answers: Are ACOs Ready to Manage Medications?

NPC Chief Science Officer Robert Dubois, MD, PhD, will present recommendations on how to optimally use medications to achieve success in value-based...
Press Release

Study Offers Solutions for Filling Gaps in Accountable Care Measure Sets

(Washington, DC, October 13, 2015)—Measurement in accountable care programs is essential for promoting quality improvement and balancing financial...
Press Release

NPC Comments on CMS’ Announcement to Allow Broader Access to Publicly Funded Databases

(Washington, DC, June 2, 2015)—The National Pharmaceutical Council (NPC) today commented on the Centers for Medicare and Medicaid Services’ (CMS)...
Press Release

Improving Patient Outcomes and Costs in an ACO Through Comprehensive Medication Therapy Management

Washington, D.C. (December 4, 2014)—A case study published in the December 2014 issue of the Journal of Managed Care & Specialty Pharmacy...
Press Release

National Pharmaceutical Council, Discern Health Examine Accountable Care Measures for Specialty Care and Innovative Treatment

Washington, DC (October 28, 2014)— Measuring the quality and cost of health care is an integral part of accountable care, but new research from the...
Commentary and Testimony Page

Chain Drug Review – Commentary: “Health Care Outlook for 2015”

This commentary was originally published in the January 5, 2015 issue of Chain Drug Review.By: Dan Leonard, President, National Pharmaceutical...
Commentary and Testimony Page

Keeping Our Eye on the CER Ball

Until the cherry blossoms begin to bloom later next month, most of the water cooler conversations in Washington will focus on the federal budget....
Commentary and Testimony Page

Leveling the Playing Field? Could a Landmark Decision Alter the CER Communications Landscape?

A growing chorus of voices is publicly sharing data on the effectiveness of treatment options, but one viewpoint has long been shut out of key areas...
Commentary and Testimony Page

Living Up to Its Name? The Role of Patient-Centered Research

Anyone who has ever received bad news from his or her health care provider or held a loved one’s hand when a diagnosis was delivered can understand...
YouTube Videos

Anthem's Malin: Having Patient-Level Data Can Improve Clinical Care Pathways

The success of a clinical care pathway is related to the breadth and quality of the information that is available to organizations developing...
YouTube Videos

Anthem's Dr. Malin on Care Pathways: Their Implementation and Evaluation

Dr. Jennifer Malin, medical director, oncology and care management, Anthem, Inc., explains that her organization uses care pathways to address the...
YouTube Videos

Anthem's Dr. Malin on Clinical Care Pathways and Innovation

Could clinical care pathways help innovation? Anthem Inc.'s Dr. Jennifer Malin, medical director, oncology and care management, says it’s a strong...
YouTube Videos

Anthem's Malin: Communication Is Key to Success of Care Pathways

To make a clinical care pathway successful, “you have to work on many levels to engage providers,” says Dr. Jennifer Malin, medical director,...
Blog Post

Bundled Payments: Opportunities and Challenges

As use of bundled payments increases, how do health system stakeholders minimize the risk of unintended consequences and maximize chances this...
Blog Post

NQF’s Annual Conference Drives Conversation Around Quality Measures, Value-Based Care

As the health care system moves toward one emphasizing the value of care over the volume of care, quality measures play a key role in this shift to...
Blog Post

NPC’s Dr. Dubois Answers: Are ACOs Ready to Manage Medications?

NPC Chief Science Officer Robert Dubois, MD, PhD, will present recommendations on how to optimally use medications to achieve success in value-based...
Blog Post

ASCO’s Clinical Pathways Recommendations and Remaining Challenges

The American Society of Clinical Oncology (ASCO) today released its “policy statement on clinical pathways in oncology,” which acknowledges the...

Using an Electronic Medication Refill System to Improve Provider Productivity in an Accountable Care Setting

This case study highlights the critical components of Sharp Rees-Stealy Medical Group's electronic...

What Contributes Most to High Health Care Costs?

A small segment of the population—often the sickest

Solutions for Filling Gaps in Accountable Care Measure Sets

This peer-reviewed study, “Solutions for Filling Gaps in Accountable Care Measure Sets,” explores...
  •  
  • 1 of 42
  • >