Dan Mendelson: How the Shift to Value-Based Care Is Impacting Managed Care Pharmacy

Dan Mendelson, MPP, founder, Avalere Health, discusses how the shift to value-based care has impacted managed care pharmacy.

TranscriptHow has the shift to value-based care impacted managed care pharmacy?

The shift to value-based care is fundamental to how health plans want to pay, and that’s the important place to start. So, health plans are being paid on the basis of value whether it be lowering cholesterol or managing HbA1Cs of patients. And the more effectively they can do that, the more they’re going to get paid by the federal government and the more effectively they’re going to present to their customers.

Then think about the managed care pharmacy setting and kind of how that engages. That sets up a range of different incentives that then need to be translated down into contracting for pharmacy and into the delivery of drugs to patients, whether it be in the pharmacy or whether it be specialty injected.

This may be outcomes-based contracting, which I think is increasing rapidly and will continue to increase rapidly as the data capabilities progress and as the payers become more sophisticated. I think one other thing on outcomes-based contracting is that the government knows that outcomes-based contracting is the way of the future, and they’re trying to figure out ways to facilitate these kinds of contracts. So, I think that’s really a big one.

I would say also that the ability to engage with patients on a range of clinical issues is important for the achievement of outcomes. So, to the extent that a plan can enable pharmacists to better engage with patients, it’s going to be better at achieving the outcomes for which it’s being held accountable.