One of the essential changes in the science landscape for 2020 lies within the shift from the standard fee-for-service model to a value-based care payment system. The shift demonstrates a growing awareness encompassing the social determinants of health (SDoH) as well as the ever-increasing knowledge of the value of health care providers in limiting hospitalizations and in increasing overall case outcomes.
Over the past five years, there has been a 7-fold increase in the number of states and regions implementing value-based payment programs, now totaling 48 nationwide. Furthermore, more than 20 countries have developed their valued-based care efforts, including new leadership by New York, Pennsylvania, and Vermont.
Given the contrary result of the fee-for-service model on the SDoH, the shift from the earlier model in favor of a value-based care model is required to proceed. SDoH can save a potential 1.5 trillion dollars in health care spending, according to Healthcare IT News.
Value-Based Care
“Drugstores have a ton to offer in value-based care, and probably, value-based care has a ton of events for drugstores as well, as [providers] are focused on results. Both the pills and making sure those medicines are properly used is a big part of achieving good outcomes.
Thus good value, which is at the core of value-based care,” Kurt Proctor, Ph.D.,RPh, senior vice president of Strategic Initiatives at the National Community Pharmacists Association, said in an audience with Pharmacy Times.
OTC resolutions are proposed to transform the role of neighborhood drugstores in inpatient health and health care as a whole. As added benefit service and revenue streams grow and adapt, retail drugstores will improve their SDoH solutions offerings, from health screenings to joining with cases in the SDoH continuum through food, clothing, transportation, and more.2
In an account with Managed Healthcare Executive, Thomas R. Bizzaro, RPh, vice president of Health Policy and Industry Relations of First Databank, Inc, said that health plans investing in addressing SDoH would likely see a positive impact in areas such as prescription adherence.2
Health Care Requirements
“SDoH has been exposed to the health care provider for many years, but the idea hasn’t been a focal point in the total care of the case until more recently. There’s a growing recognition that not only do you need to treat physiology for illness administration and prevention, but you also need to recognize whether members need help with social care that can affect their well-being and clinical issues—including those related to pharmacology,” Bizzaro told Managed Healthcare Executive.
Common determinants of health are conditions in the requirements in which people are born, live, learn, work, play, worship, and age that impact a wide range of health, functioning, and quality-of-life issues and risks.
Health care providers recognize Value-based care as a means for compensation for the improved services that they are positioned to give patients to address SDoH. These payment programs support a 3-part aim: better care for people, better health for populations, and lower prices.
To Proctor, pharmacists, who lead the way in documenting their enhanced services through blood pressure monitoring or A1C, as well as addressing the changing terminology in the health care landscape, will have the most significant impact.
“We have to recognize the contribution of value that we have, but we also have to understand that we’re not going to be recognized for that on the payer’s side of the equation if we’re not documenting what we’re doing,” Proctor told Pharmacy Times.
“[Providers] wouldn’t think for 1 second if they didn’t document a prescription, but we’re not going to be paid for our services and care if we don’t document it. So, we need to change our orientations. Then, that documented care will make the case to the payer’s side that pharmacists have an important role to play in value-based care.”
Delivery Networks
Community pharmacists have been addressing the SDoH for years, working as vital members of their communities by interacting with patients every day. Using training programs that formalize these roles will ultimately benefit the pharmacy staff and patients as a whole.
One way to do this is through collaboration with integrated delivery networks. Proctor explained that once NCPA brought together pharmacists in integrated health delivery networks with community pharmacists from their area, collaboration improved.
“Upon recognizing that they share patients, but that they never talk to each other and do not coordinate, they immediately took off and discussed ways that they could work together and what access to whose data and sharing information,” Proctor told Pharmacy Times.
“It was encouraging to see. It’s just a matter of a realization that these community pharmacists exist, that they’re seeing the same patients that are seen in the integrated delivery networks, and share the same desire for possible outcomes for these patients.”
Ultimately, it is not a matter of abandoning dispensing, Proctor noted, but rather understanding that there is a greater need to address the patients’ overall health outcome through collaboration.
To Sum Up
“It’s great to know that the day will come that liberating on these outpatient care activities and accomplishing these outcomes is what will give stores the privilege to dispensing those directions,” Proctor told Pharmacy Times.
“Payers are going to want their cases going to those providers whose sufferers are delivering positive outcomes, the lower total health care cost. That’s what will maintain the right of dispensing those medicines, are patients achieving those sorts of issues.”
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