Value-Based Care

Question 1

Value-Based Care

Purpose

Answer 1

• Improve patient experience
• Reduce per-capita medical spend
• Improve population’s health

Question 2

Value-Based Care

Value-Based Care Framework Capabilities

Answer 2

• Strategy
• High-Performance Network Management
• Population Health Management and Quality
• Enterprise Risk and Financial Management
• Data Management
• Consumer Engagement
• Analytics and Reporting
• Enabling Technology
• Business Operations Excellence
• Product Leadership
• Organizational Change and Talent Acquisition

Question 3

Value-Based Care

Value-Based Care Framework Capabilities

Answer 3

• Strategy
• High-Performance Network Management
• Population Health Management and Quality
• Enterprise Risk and Financial Management
• Data Management
• Consumer Engagement
• Analytics and Reporting
• Enabling Technology
• Business Operations Excellence
• Product Leadership
• Organizational Change and Talent Acquisition

Question 4

Value-Based Care

Strategic Considerations

Answer 4

• Overall strategy objectives
• Provider strategic motivation
• Balance risk appetite
• Financial Implications for Providers
• Possible Outcomes by Modeling:
  
  • Traditional Financial Levers
  • Clinical Interventions
  • Underlying cost structure of providers

Question 5

Value-Based Care

8 Medication-Use Quality Measures on Which to Evaluate Pharmacies

Answer 5

• Medication Adherence
  
  • Hypertension
  • Cholesterol
  • Diabetes
• Dx Management
  
  • Statin use in persons with diabetes
  • Suboptimal control of asthma
  • Absence of controller inhaler in asthma patients
  • Pharmacist health coaching
• Patient Safety
  
  • High risk Medication in Elderly

Question 6

Value-Based Care

Reasons Initial Metrics were Selected for Pharmacy Initiative

Answer 6

• Address areas of high priority
• Can be directly impacted by pharmacists
• Easy to track and understand

Question 7

Value-Based Care

Initiative Phases

Answer 7

1. Performance Reflection (Reflect on scorecards)
2. Performance Disclosure (Final scores)
3. Performance Accountability (Tie pharmacy reimbursement to overall performance)

Question 8

Value-Based Care

Initial Objectives of Pharmacy Initiative

Answer 8

• Assist pharmacies to identify most high-need patients for intervention
• Support evolution of pharmacy profession to delivery high-quality patient-centered care
• Performance feedback to facilitate improvement