Framework Helps ACOs Leverage Pharmaceuticals to Realize Quality, Cost Goals

Medications are more than an item on the balance sheet for health care providers. Pharmaceuticals offer a route to manage costs while achieving recognized standards for quality patient care. The role of medications is growing in importance as more providers set up accountable care organizations (ACOs) and other value-based care programs in an effort to deliver high-quality, affordable care.

To support this delivery model, the National Pharmaceutical Council (NPC), the American Medical Group Association (AMGA) and the Premier health care alliance partnered with seven provider organizations to create the Working Group on Optimizing Medication Therapy in Value-Based Healthcare. Together, the group developed a framework to help ACOs and other value-based care providers evaluate ways they can use pharmaceuticals to realize these goals. An article describing the framework was published in the July 2012 issue of the American Journal of Managed Care.

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 crucial guidance to providers as they adjust to the industry’s shifting landscape. With this tool in hand, providers will be better positioned to ensure patients can access the medications they need and ACOs can achieve recognized quality metrics and cost-savings goals.

Several health blogs have published posts about the research: