In an article published in a Health Affairs blog, CVS Caremark Corp. chief medical and scientific officers and others commented on a missing piece in the current approach to accountable health care models.


CVS Caremark, accountable health care models, Health Affairs, prescription drugs, pharmacy, William Shrank, health care payment, Centers for Medicare and Medicaid Services, CMS, Medicare Part D, Andrew Sussman, Troy Brennan, Patrick Gilligan, accountable care organizations, ACOs




































































































































































































































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ACOs asked to rethink role of Rx

July 7th, 2014

WOONSOCKET, R.I. – In an article published in a Health Affairs blog, CVS Caremark Corp. chief medical and scientific officers and others commented on a missing piece in the current approach to accountable health care models.

They maintain that although reforms to the health care payment system are transforming incentives for health care providers, the cost and ultimate value of prescription drugs has not been included.

The authors assert that as the Centers for Medicare and Medicaid Services (CMS) and policy makers reconsider the role of pharmacy in health care payment and delivery reform, retail pharmacies, pharmacy benefit managers and retail-based clinics are already implementing innovative approaches to encourage medication adherence.

“This paper provides insight into a blind spot in the current approach to accountable care management, the role and impact of pharmacy care in promoting quality and lowering costs,” said Dr. William Shrank, chief scientific officer of CVS Caremark and lead author of the paper. “We believe the appropriate use of prescription drugs will be central in realizing the vision of higher-quality, lower-cost health care. Our pharmacies and Part D administrators are already actively engaged in programs to improve adherence, despite the lack of formal incentives.”

Also contributing to the post were Andrew Sussman, president of MinuteClinic; Patrick Gilligan, senior vice president of health systems alliances; and Troy Brennan, executive vice president and chief medical officer.

The blog post highlights the absence of direct incentives encouraging the participation of Medicare Part D plans and pharmacists in managing care and presents a rationale for the role that pharmacy can play in payment reform. The authors also review several approaches that Part D plans and pharmacies have already introduced in the market that consider the value prescription drugs provide while optimizing ­adherence.

These approaches include realigning incentives to promote adherence for cost-effective generics and monitoring pharmacy data to identify nonadherence and initiate pharmacist-led counseling and interventions.

Also examined are the role of retail health clinics in supporting accountable care organizations (ACOs) in delivering primary care services integrated with the medical home, the role of pharmacies in managing chronic diseases and keeping people healthy through screenings and convenient vaccinations.

“As ACO regulations continue to evolve, policy makers and providers need to be aware of the innovative solutions that have arisen to meet the needs of providers in a new payment landscape to promote more efficient, appropriate and consistent use of medications,” said Patrick Gilligan, senior vice president, health system alliances. “To be successful, any policy solution should support a nuanced view of the value of medication therapy in improving health outcomes and reducing costs.”

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