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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.
Blog Post

Medication Management in ACOs: Are They Ready?

Are accountable care organizations (ACOs) prepared to utilize medications to achieve the best patient health outcomes, while meeting their financial...
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...
Newsletter Volume

E.V.I.dently January 2016

MessageThe Importance of Evidence, Value, Access and Innovation in 2016In his annual health care outlook, NPC President Dan Leonard explains why...
Blog Post

CER Tweets of the Week: JCER Editorial on Treatment Sequences in Oncology; JNCCN Discusses CER Database Analyses (December 14-18, 2015)

What were comparative effectiveness research (CER) stakeholders talking about on Twitter this week? Popular topics included the Journal of...
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...
Press Release

New Peer-Reviewed Study Shows Mixed Results in ACO Medication Readiness To Achieve Quality, Cost Goals

Washington, D.C.—As Accountable Care Organizations (ACOs) gain traction among both private and public payers, so do expectations that these networks...
Press Release

Pharmaceuticals Play Key Role in Achieving ACO Quality, Cost Goals

WASHINGTON, DC, July 18, 2012–As health care providers set up accountable care organizations (ACOs) and other value-based care programs,...
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

Medicare Part D, Adherence, and the Value of Pharmaceuticals

Before enactment of the health care reform legislation two years ago, the most significant change in the health care landscape over the past decade...
Commentary and Testimony Page

Proposed ACO Rules Raising More Questions Than Answers

This month, Washington, DC, has been buzzing about “ACOs” – accountable care organizations – now that the Centers for Medicare and Medicaid Services...
Commentary and Testimony Page

What Will 2011 Hold for CER and PCORI?

When future historians consider health care, they may well look back on 2010 as a watershed year in America. The issues and events that occurred last...
YouTube Videos

Mind the Gap: Improving Quality Measurement in Accountable Care Systems

The National Pharmaceutical Council's (NPC) webinar, Mind the Gap: Improving Quality Measurement in Accountable Care Systems, was moderated by...
YouTube Videos

A Layered Approach for Quality Measurement

Tom Valuck, MD, MHSA, JD, partner, Discern Health, explains explains that quality measures should be fit for purpose: measures that are suitable for...
YouTube Videos

Accountable Care Measures for High-Cost Specialty Care and Innovative Treatment

Tom Valuck, MD, MHSA, JD, partner, Discern Health, is a co-author of the white paper "Accountable Care Measures for High-Cost Specialty Care and...
YouTube Videos

A Modular Approach for Quality Measurement

Tom Valuck, MD, MHSA, JD, partner, Discern Health, explains that in some cases, it may not be feasible to assess quality for a specific patient...
Blog Post

Medication Management in ACOs: Are They Ready?

Are accountable care organizations (ACOs) prepared to utilize medications to achieve the best patient health outcomes, while meeting their financial...
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

CER Tweets of the Week: JCER Editorial on Treatment Sequences in Oncology; JNCCN Discusses CER Database Analyses (December 14-18, 2015)

What were comparative effectiveness research (CER) stakeholders talking about on Twitter this week? Popular topics included the Journal of...
Blog Post

#TBT: Risk-Sharing Agreements & Innovative Payment & Delivery Models

As part of our Throwback Thursday blog series, we’re taking a look at a topic that’s currently in the news and tagging it with previous research...

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...

Solutions for Filling Gaps in Accountable Care Measure Sets

This peer-reviewed study, “Solutions for Filling Gaps in Accountable Care Measure Sets,” explores...

Best Practices: An Electronic Drug Alert Program to Improve Safety in an Accountable Care Environment

A peer-reviewed study, "Best Practices: An Electronic Drug Alert Program to Improve Patient Safety...
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