Understanding the Shift to Value-Based Care for Pharmacy, Part I

Value-based care. Not a new term in healthcare, or even clinical pharmacy, but a current buzzword across the industry today, especially as more commercial payors buy into the concept. In this two-part blog series we’ll explore this buzzword even more as we look closely at how payors define it, why it’s worth considering, how it can work in pharmacies and what benefits pharmacies and patients can expect.

What is pharmacy value-based care?

The term value-based care refers to a form of reimbursement that directly links payments for care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness.

Improving patient outcomes has always been at the core of why pharmacists do what they do. Beyond the HEDIS score, pharmacists work hard every day to assist their patients in building healthier lives, which is why they went into the profession in the first place.

How do payors define value-based care?

For CMS, “Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare. These programs are part of our larger quality strategy to reform how health care is delivered and paid for.”

From a payor perspective, better outcomes equate to healthier patients and lower costs. Due to the powerful tie to outcomes, value-based care gives payors a way to ensure provider accountability. Read more >