Value-Based Care Models Can Help Pharmacies Improve Operations

Value-based care is a health care model that focuses on the patient experience, quality of care, and provider performance, with a goal of managing a patient’s overall health while considering their individual health goals.¹ The model offers patients an easier time when navigating the health care industry and more options in how they receive care.

At the Spring 2024 Total Pharmacy Solutions Summit, held virtually on April 13, Sandra C. Canally, RN, founder and CEO of The Compliance Team, discussed the goals, benefits, and opportunities of value-based care in pharmacy, as well as how to improve operations and clinical services.

Sandra C. Canally, RN, founder and CEO of The Compliance Team, discussed the goals, benefits, and opportunities of value-based care in pharmacy. | image credit: MP Studio / stock.adobe.com

“What is value-based care?” Canally asked during the session. “[It] has many different definitions. But an easy one is, it’s an evolving health care model moving pharmacy from transaction-based care to clinical-based services designed to improve patient satisfaction and outcomes. In other words, you’re prioritizing quality over quantity. It’s far more beneficial to the patient and, hopefully, cost-effective to the pharmacist.”

READ MORE: Data, Collaboration Can Help Unlock the Full Potential of Value-Based Care

Read on for Some Key Takeaways from Canally’s Session:

• The Centers for Medicare and Medicaid Services (CMS) expects all Medicare payments to go through value-based models by 2030. The agency’s vision for improving health care delivery can be summed up in 3 words: better, smarter, and healthier.
• The CMS value-based care model focuses on using incentives to improve care, tying payment to value through new payment models, and changing how health care is given through better teamwork, better coordination across health care settings, more attention to population health, and using the power of health care information.
• Pharmacists face many clinical challenges on a daily basis, such as ineffective medication management, medication errors, and poor medication adherence. A value-based model can help alleviate some, if not all, of these challenges.
• Value-based care models can lead to a number of positive outcomes for patients, including improved medication adherence, reduced hospital admissions, lower health care costs, and increased satisfaction.
• For pharmacies, the goal of value-based care is to move the pharmacist from being the medication dispenser to being an indispensable patient partner and a key member of the clinical care team.
• Value-based care standards for a pharmacy include giving patients advanced access to services like counseling and medication management sessions, providing assessments to patients with complex medication management, having a process in place to improve medication adherence among high-risk patients, and implementing care coordination among other health care providers for high-risk patients.
• Although accomplishing all of these standards can be difficult, Canally said the pharmacies that are ready for these new models will be the first ones to benefit from them.
• Pharmacies should get value-based care accreditation because it can improve and streamline clinical services, improve overall operations, and help identify areas that are in need of improvement.
• By adopting value-based care, a pharmacy can help increase prescribers’ prescriptions through better monitoring and management of complex patients.

“Pharmacists who embrace value-based care will be well positioned to meet the needs of their patients and the health care system in the future,” Canally said. “Value-based care models can lead to a number of positive outcomes, including…not only improving medication adherence but reduced hospital readmissions [and] lower health care costs because [patients] are not going back for…readmissions; they’re not going to the [emergency department] because through your counseling, you’re preventing them from needing to do that.”

Visit drugtopics.com/Spring24TPSS to watch all of the Total Pharmacy Solutions Summit sessions on demand.

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Reference

1. Value-based care. Centers for Medicare and Medicaid Services. Accessed May 3, 2024. https://www.cms.gov/priorities/innovation/key-concepts/value-based-care