From accountable care organizations and integrated delivery networks to bundled payments and value-based insurance design, innovative payment and delivery models are gaining traction all over the country. The National Pharmaceutical Council's research takes a closer look at these new payment models and identifies the critical role biopharmaceuticals play in this changing health care environment.
Accountable Care Organizations (ACOs)
Accountable care organizations have the potential to improve the quality of care while lowering costs. How are ACOs using biopharmaceuticals to help them achieve this goal?
Biopharmaceutical innovators, payers and patients can benefit by risk-sharing agreements, which link coverage and reimbursement levels to a drug’s effectiveness.
Bundled payments are value-based payment models reimbursing for clinically defined episodes of care, with the goal of maintaining health care quality while reducing costs.
Clinical Care Pathways
Care pathways, also known as clinical pathways or integrated care pathways, are typically characterized as a method for managing patient care based on clinical practice guidelines.
As the health care system moves toward emphasizing the value of care over the volume of care, quality measurement can promote system-wide improvement. Measurement influences priorities and care delivery, so it is important to design and implement quality measurement thoughtfully.