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Choosing Evolution over Extinction: Integrating Direct Patient Care Services and Value-Based Payment Models into the
Amanda R Mercadante1, Mai Yokota1, Angela Hwang1
1College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766, USA.
Pharmacy (Basel, Switzerland)
|July 30, 2020
Summary
Pharmacy Benefit Managers (PBMs) have disrupted healthcare payments, increasing costs and limiting pharmacist roles. Proposed collaborative models aim to fix these issues, expand pharmacy services, and improve patient care.
Area of Science:
- Health Economics
- Pharmacy Practice
- Healthcare Policy
Background:
- The current American healthcare payment model has empowered Pharmacy Benefit Managers (PBMs), raising concerns about the pharmacy profession, particularly in community settings.
- Reimbursement plans, intended to benefit stakeholders and reduce patient costs, have paradoxically increased expenses for involved parties.
- Gaps in care and underutilization of pharmacists' clinical skills persist due to the healthcare structure and lack of federal support for pharmacy-led services.
Purpose of the Study:
- To analyze the impact of Pharmacy Benefit Managers (PBMs) on healthcare payment models and the pharmacy profession.
- To propose collaborative payment models to address financial challenges and improve healthcare delivery.
- To explore the potential for expanding pharmacists' roles and enhancing patient benefits within the healthcare system.
Main Methods:
- Review of the existing American healthcare payment structure and the role of PBMs.
- Analysis of the financial implications of current reimbursement plans on stakeholders.
- Exploration of four proposed collaborative payment models designed to mitigate financial issues and enhance pharmacy services.
Main Results:
- Current reimbursement plans have not achieved intended cost savings and have increased expenses.
- Underutilized clinical skills of pharmacists represent a gap in care delivery.
- Proposed collaborative models offer potential solutions to financial problems and could expand pharmacy career paths.
- The COVID-19 pandemic underscored the essential role of pharmacists and community pharmacy settings.
Conclusions:
- The current healthcare payment system, influenced by PBMs, requires reform to address rising costs and service gaps.
- Collaborative payment models present a progressive approach to modernize the healthcare system and leverage pharmacists' expertise.
- Expanding pharmacy services can lead to improved patient outcomes and benefits for all healthcare stakeholders.
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