Pharmacies can expand role in offering value-based care

By John T. Standley

The U.S. health-care system is afflicted with a debilitating chronic illness - rising costs.

According to the Centers for Medicare and Medicaid Services, health spending could top $10,000 a person this year for the first time.

Fortunately, there's a remedy for this disease. It's called value-based care, and it represents a fundamental change in the way we pay for health care.

Instead of paying health-care providers for what they do to a patient, value-based care compensates them for how their patients do after they leave the doctor's office.

By emphasizing outcomes instead of inputs, value-based care can improve patient health - and cure our nation's health-cost disease.

That disease has reached epidemic proportions.

In 2013, U.S. health-care costs hit $2.9 trillion. Spending is projected to increase 5.7 percent annually through 2023. By then, health costs will account for 19.3 percent of the economy.

That hits consumers squarely in the pocketbook. Employees now pay nearly 37 percent of their own premiums and out-of-pocket costs. That's up from 34.4 percent in 2011.

The problem stems from how we pay for care.

Traditionally, providers have been compensated for the number of checkups, tests, surgeries, and other services they have administered. Doctors, hospitals, and the like receive payment even if the services they order are unhelpful or unnecessary.

Value-based care flips the script - by paying providers according to the quality of care they deliver, not the quantity.

The government has laid out a bold vision to transform our nation's health-care delivery system according to the principles of value-based care. In January, U.S. Health and Human Services Secretary Sylvia Burwell announced a historic goal to shift 30 percent of Medicare spending toward value-based care models by the end of 2016 - and 50 percent by 2018.

In March, President Obama and Burwell launched the Health Care Payment Learning and Action Network. This consortium of private payers, providers, employers, states, and consumers is working to accelerate the adoption of alternatives to the conventional fee-for-service model, like value-based care.

Pharmacies can play an important role in achieving the network's goals. To see how, consider one of American health care's biggest cost drivers: the inability of patients to consistently take their prescription medicines.

Currently, one in two patients fails to adhere to the prescription regimen ordered by his or her doctor. That failure exacerbates basic illnesses and ailments. Chronic diseases that could be managed with a simple pill metastasize into trips to the emergency room or extended hospitalizations.

This lack of prescription adherence costs the American health-care system nearly $300 billion annually. And it's responsible for about 125,000 deaths and 10 percent of all hospitalizations each year.

Pharmacists can address the adherence crisis head on.

Many are teaming up with doctors, nurses, hospitals, and other health providers to coordinate patient care. As part of my company's Rite Aid Health Alliance, for instance, our pharmacists and health coaches are partnering with medical providers to help patients with chronic diseases, like diabetes or hypertension, manage their conditions better.

Improving adherence would save significant amounts of money. The Congressional Budget Office estimates that a 1 percent increase in prescriptions filled by Medicare beneficiaries would reduce medical spending by 0.2 percent. That might not seem like much - until one considers that Medicare spends nearly $600 billion a year.

Pharmacists can also hasten the shift to value-based care by helping patients avoid getting sick in the first place. America's more than 290,000 pharmacists interact with patients every day. They're uniquely positioned to both deliver preventive care - like immunizations - and educate patients about making healthier lifestyle and food choices.

What's more, 93 percent of Americans live within five miles of a pharmacy. That convenience places pharmacists in a key position to help folks obtain treatment for illnesses before they grow severe.

And because there's a pharmacy in virtually every community, they're also well-suited to serve as hubs for the delivery of critical social and public-health services.

Pharmacies have expanded their roles and their services. In doing so, they are helping the United States embrace value-based care - which is poised to improve our nation's fiscal and physical health.