Integrating chronic disease management with new health delivery mechanisms

July 19, 2012

We’ve long known that the key to addressing our greatest 21st century health care challenges – controlling costs while achieving improved health outcomes – lies in attacking chronic disease. With the implementation of health reform, the question we’re facing is how to mesh this goal with new health delivery mechanisms, such as accountable care organizations (ACOs), designed to move our U.S. health care system from a fee-for-service orientation to one based on value.

A paper published in this month’s issue of the American Journal of Managed Care provides important insight into how value-based care can, in fact, lead to improved disease treatment and prevention while also containing cost growth.

The report, The Role of Pharmaceuticals in Value-Based Health Care: A Framework for Success, was developed by experts from the National Pharmaceutical Council, American Medical Group Association, Premier healthcare alliance and seven of the nation’s leading health providers. Their work makes the critical point that pharmaceuticals are an essential component in minimizing costs and achieving overall health objectives.

And, from the PFCD standpoint, medications are an essential element in attacking chronic disease and making our health system more cost-effective.

The paper’s authors make valuable points about how to make optimal use of pharmaceuticals in value-based care, specifically:

  • We cannot treat medications as an isolated expense, a separate “silo” of care. Drugs have to be viewed as an integral part of the patient care continuum.
  • There is no such thing as a “one size fits all” approach to medication therapy management. Achieving best outcomes, both clinically and economically, hinge on shaping therapy according to the patient’s condition.
  • It is essential to use composite risk to identify patients who are vulnerable to drug-drug, drug-disease or polypharmacy concerns.
  • If an ACO or other value-based system has incentives to achieve cost savings, there must be a metric to detect underuse of pharmaceuticals. Underuse can lead to exacerbated conditions and greater costs in the long run.

As the dialogue on how to achieve value-based care continues, policymakers and providers would do well to heed the words of one of the paper’s authors, National Pharmaceutical Council Chief Science Officer Robert Dubois, M.D., who said, “It is crucial for ACOs to view prescription drugs as a tool, not simply an expense.” In combating chronic disease, this is a vital approach

Link to paper