WOONSOCKET, R.I. — In an article published Wednesday in the Health Affairs blog, CVS Caremark chief medical and scientific officers and others commented on a missing piece in the current approach to accountable healthcare models.
While reforms to the healthcare payment system are transforming incentives for healthcare providers, the cost and ultimate value of prescription drugs has not been included, the retailer stated. As the Centers for Medicare and Medicaid Services and policy makers reconsider the role of pharmacy in healthcare payment and delivery reform, retail pharmacies, pharmacy benefit managers and retail-based clinics are already implementing innovative approaches to encourage medication adherence in order to improve outcomes and lower costs.
"This paper provides insight into a blind spot in the current approach to accountable care management, the role and impact of pharmacy care in promoting quality and lowering costs," said William Shrank, chief scientific officer of CVS Caremark and lead author of the paper. "We believe that the appropriate use of prescription drugs will be central in realizing the vision of higher quality, lower cost health care and our pharmacies and Part D administrators are already actively engaged in programs to improve adherence, despite the lack of formal incentives."
The blog post highlights the absence of direct incentives encouraging the participation of Medicare Part D plans and pharmacists in managing care, and presents a rationale for the important role that pharmacy can play in payment reform. The authors also review a number of approaches that Part D plans and pharmacies have already introduced in the market that consider the value prescription drugs provide, while optimizing adherence. These approaches include:
- Realigning incentives to promote adherence for cost-effective generics;
- Monitoring pharmacy data to identify nonadherence and initiate pharmacist-led counseling and interventions;
- The role of retail health clinics in supporting Accountable Care Organizations in the delivery of high-quality, efficient primary care services that are integrated with the medical home;
- The role of pharmacies in both managing chronic diseases and keeping people healthy through screening programs and convenient vaccinations; and
- Reducing the risk of hospital readmission through hospital bed-side delivery of discharge medications and in-home medication reviews post-discharge.
"As ACO regulations continue to evolve, policymakers and providers need to be aware of the innovative solutions that have arisen to meet the needs of providers in a new payment landscape to promote more efficient, appropriate and consistent use of medications," said Patrick Gilligan, SVP health system alliances at CVS Caremark. "To be successful, any policy solution should support a nuanced view of the value of medication therapy in improving health outcomes and reducing costs."
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