Making the Best Use of Medications for Every Patient: The Role of Pharmacy in Value-based Care

Pharmacist in Value Based Care

Pharmacists and pharmacy technicians are indispensable partners in the delivery of value-based care. Their expertise in medication access, adherence, and optimization makes them valuable assets to any healthcare team. Embracing this partnership and leveraging pharmacists’ and technicians’ skills improves patient outcomes and reduces healthcare costs.

Pharmacy’s Impact on Value-based Care

Medication Access

Many beneficiaries, especially those with chronic conditions, rely on consistent and affordable access to prescription drugs. Medication adherence is closely linked to medication access. Financial barriers and changes in drug coverage can hinder access, leading to nonadherence and poor health outcomes.  Pharmacy team members can ensure patients have reliable access to necessary medications through Medication Assistance Programs and by supporting providers with prior authorizations and formulary navigation.

Medication Adherence

Not only does medication adherence affect health outcomes, but it also plays a significant role in evaluating the performance of Medicare Advantage and Part D plans as part of the Medicare STAR ratings. Adherence to prescribed medications, especially for chronic conditions, is a key measure, accounting for up to 41% of the overall rating.*

Pharmacists and technicians in value-based models collaborate with patients, caregivers, pharmacies, and providers to navigate barriers to improving medication adherence. As part of the healthcare team, they can address social determinants of health to improve medication adherence.

* Varies by quality program

Medication Optimization

  1. Comprehensive Medication Management: Pharmacists are medication experts. They assess medications to determine the appropriateness for the individual patient. This includes medication effectiveness, safety, and healthcare goals specific to the patient. Pharmacists not only assess prescription medication, but all medications, including OTCs, vitamins, and supplements to make sure they are optimized for the patient.
  2. Disease State Programs: Medications are used in the treatment of most chronic conditions. Often these medications are expensive, require teaching for administration, and have preventable side effects. Pharmacists play a crucial role in optimizing medications for chronic diseases, such as diabetes and hypertension. Their interventions lead to better disease control, fewer complications, and reduced hospitalizations.
  3. Transitions of Care: During transitions, pharmacists assess patients’ medication lists, identify potential risks, and provide crucial information and education. Their expertise in medication management helps prevent errors and ensures continuity of care, particularly when patients move between different healthcare settings, such as from hospital to home or another facility. Embedding pharmacists on the transitions of care team has been shown to decrease readmission rates.
  4. Drug Information & Education: Pharmacists are well-positioned to provide patient education on medications, disease management, and lifestyle modifications. This empowers patients to take an active role in their health and improves adherence to treatment plans.

As the healthcare industry continues to evolve from fee-for-service to value-based care, pharmacists and technicians will continue to expand their role as indispensable members of the care team. Their expertise and trusting relationship with the patient plays an important part in reaching the quintuple aim: lowering per capita cost of care, enhancing the patient experience, enhancing the provider experience, increasing population health, and establishing health equity.

About the Author

Rebecca Grandy

Rebecca Grandy, PharmD, BCACP

Director of Pharmacy Services at CHESS