The Problem

The U.S. health care system is in need of change to improve the health and well-being of patients and populations and reduce overall health care costs. Limitations of the current health care system result in major gaps between evidence and practice, suboptimal quality, inequitable patterns of utilization, poor safety and unsustainable cost increases. The U.S. spends considerably more on medical care than any country in the world, yet it continues to rank low on most measures of health outcomes compared to other developed countries. Medications remain the most common of all health care interventions but can be associated with harm due to adverse reactions or inappropriate utilization, leading to poor quality care and immense cost for the health care industry. The appropriate use and management of drug therapy is a critical issue that must be addressed to improve national health care.

The Opportunity

One of the challenges confronting the U.S. health care system is delivering high-value, effective therapies and clinical services that provide the best health outcomes. The Affordable Care Act proposes numerous ways to extract greater value from the U.S. health care system framed around three core tenets of care: Quality, Access and Cost. The overriding emphasis and focus of payers and providers has been on controlling total health care spending and “Bending the Cost Curve” as ACA is being implemented. To achieve this objective, more efforts are being directed towards defining, delivering and measuring value for patients, with value being embedded as an integral part of health care and treatment decisions. The importance of medication management within population health is gaining traction based on the need to proactively manage and optimize medication use (especially for patients with chronic conditions) and quality metrics are being tied to reimbursement through public programs and commercial value-based contracts.

 

The Impact

community-pharmacyThese collaborative efforts will be directed towards raising awareness and helping implement rigorous evaluations, solutions, best practices, and policies toward improving patient health outcomes and health care delivery. One of the key objectives of policy shaping will be to help define, build, and champion new value-based payment models that account for value-added services aimed at optimizing medications. We envision highly collaborative research that will result in endorsement of new and innovative approaches of care delivery at the state (Medicaid) and federal (Medicare) levels and encourage adoption by payers and providers across the state and the nation. The true impact of this collaboration on human health and health care delivery will be realized by carrying out our mission toward a shared vision to define and deliver value in pharmacy practice and patient-centered care delivery for system-wide benefit.

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