This article summary is excerpted from two in-depth pieces recently published by Carelon:
How value-based care is reshaping the pharmacy
The value of independent pharmacies in value-based care


The promise of value-based care models

What if quality healthcare didn’t mean higher spending, especially on treating chronic diseases? Such is the promise of progressive value-based care models that tie in pharmacy. These new, patient-centric approaches to value-based care can lead to reduced spending and improved health outcomes.

Improving affordability and outcomes often involves addressing the impact of drugs on healthcare costs. Pharmacists play a critical role, helping ensure safe and appropriate medication use — an important task given that drugs account for around 15% of total U.S. healthcare spending. 

Healthcare organizations are exploring new care models for their members with high risks or needs, too, with pharmacies near the center of these models, and for good reason: 80% of treatments today for chronic diseases involve medication therapy.

Tapping into the power and value of quality

A pivot toward value over volume, along with a growing shortage of primary and specialty care physicians, makes independent, community pharmacies key contributors to the future of value-based care.

Quality measures empower providers to deliver high-quality care through collaboration and personalization. As more progressive organizations think differently about the value independent, community pharmacies offer, many are turning to pharmacy benefit managers (PBMs) to drive the value-based partnerships with pharmacies.

PBMs can identify quality provider networks in their market that excel in improving outcomes. In pharmacy, provider scorecards are used to integrate quality measures into established pharmacy practices. Measures include:

  • Clinical outcomes
  • Patient satisfaction
  • Alignment with clinical guidelines
  • Patient safety, and more

Personalized care that puts members first

Independent community pharmacies are also situated to provide personalized disease management and preventive care services. For members with complex treatment plans, value-based care provided by independent community pharmacies includes:

  • Medication therapy management programs
  • Medication adherence programs
  • Patient education and community engagement, and more

CarelonRx works with these pharmacies to provide data-based decision support. By forming partnerships through digital tools, web-based platforms, and data integration, we're enabling complex care for chronic conditions, such as diabetes, kidney disease, and heart disease.

"We're leveraging a clinically integrated network that plays an important role in getting all stakeholders in the care continuum to think about value-based care as a team, with the patient at the center," said Stacey Decembrele, Staff Vice President of Pharmacy Network Management and Strategy at CarelonRx.

Read the full articles discussing the transformations enabled by value-based pharmacy care on Carelon's Perspectives page. 

You may also be interested in:

Managing inflammatory conditions and specialty drug trend
CarelonRx to launch EnsureRx to help lower out-of-pocket costs

Get the latest news from CarelonRx