What Role a Pharmacist Plays in the Value-Based Care Model

As the healthcare system continues a shift toward value-based care, pharmacists are working on playing a role in this transformation. Learn how the pharmacist fits into this model and what role they can play in reducing medical errors, improving patient health and controlling costs.

A value-based payment model incentivizes healthcare providers to deliver quality care over quantity. This can help reduce the number of office visits, procedures and tests patients need.

Behavioral Health

The behavioral health sector covers various conditions and treatments that affect mental and physical health. They include psychiatric conditions, life stressors and crises, substance abuse disorders, and behavioral habits.

In the U.S., one in four adults will experience a mental illness or substance use disorder at some point. Often these issues co-occur with physical diseases or other medical conditions, such as diabetes or asthma.

A key challenge in value based care pharmacy is integrating behavioral health into the primary care environment and measuring its impact on overall health. This is complicated because behavioral health has no apparent clinical measurement of “improvement” like those in diabetes or heart disease.

To address these challenges, the AMA and seven leading medical associations have established the Behavioral Health Integration Collaborative to catalyze practical, sustainable behavioral health integration into physician practices. 

Integrating behavioral health into your primary care model requires some time and financial resources to get off the ground. The key is to find a workflow that works well for your practice size, patient population, current staff capabilities and technology. The collaborative has developed several tools and resources to assist you on this journey, including performance reporting dashboards.

Patient Education

Whether for prevention, diagnosis or treatment, patient education helps patients understand their health conditions and what they need to do to take care of themselves. It can also help improve compliance with prescribed medications and promote good healthcare habits.

Pharmacists can provide patient education using a variety of techniques. The correct method depends on the individual’s needs and learning styles. For example, some patients learn best by reading a book or watching a DVD. Others prefer hands-on teaching.

Value-based healthcare models reward doctors and other providers based on the outcomes they achieve rather than the volume of procedures or treatments they prescribe. The aim is to offer better care, improve health and lower costs.

Patient education is a vital part of the pharmacist’s role in a value-based health system. This is because well-educated patients are more likely to be satisfied with their care and take better care of themselves.

It is essential to consider the different educational needs and levels of readiness of each patient, as well as their cultural beliefs and language. Adapting teaching to the patient’s preferences, experience, and understanding can ensure they are engaged and empowered in their education.

Pharmacists can also reduce readmissions and emergency department visits by collaborating with physicians during care transitions. This can include medication reconciliation, daily education and discharge planning.

Preventive Care

The value-based care is a new way of thinking about healthcare that emphasizes quality over quantity. It aims to improve patient outcomes and reduce costs.

Unlike fee-for-service, which pays for services based on the number of procedures and patients seen, value-based models reward providers that successfully coordinate care and deliver quality health outcomes. This model also focuses on wellness and prevention to address health problems before they become major medical issues.

Preventive care is a critical element of the value-based care model because it helps reduce healthcare spending by preventing medical conditions from developing in the first place. It can help prevent complications from diabetes, heart disease and cancer.

A recent study showed that most value-based healthcare organizations firmly focused on population health management. This included using patient data to track health outcomes, integrating primary, specialty and acute care, sharing electronic medical records, improving patient engagement and leveraging technology, such as telehealth and remote monitoring.

Pharmacist is well-suited to play a role in the value-based model because they possess a wide range of skills that are vital for moving our health system toward one that values and promotes health at every level. These include a broad skill set in public health, clinical practice and medical education. They can also collaborate with physicians and other care professionals across the care continuum.

Medication Management

Managing a patient’s medication regimen is vital to achieving good health outcomes, mainly as America’s physician shortage grows and more and more people are prescribed complex medications. A well-organized and consistent medication management plan enables health professionals to watch patients closely for negative side effects or drug interactions that can cause adverse outcomes, including hospitalization or other healthcare costs.

Pharmacists play a vital role in this process by reviewing medications, identifying drug-related issues and resolving them efficiently and promptly. They can also educate patients on medication use and the risks associated with specific drugs.

For example, pharmacists can help reduce the occurrence of adverse drug reactions – which cause 1 million emergency room visits per year – by proactively reviewing a patient’s care plan and providing support to address adherence challenges. These conversations lead to improved medication adherence and prevent those patients from experiencing adverse reactions that cause hospitalizations.

As the health system moves toward value-based care, medication management is a critical component of this model that can benefit patients and providers alike. Patients who receive and take evidence-based medications as prescribed by their physicians are more likely to have good health outcomes. This improves the overall quality and reduces avoidable healthcare costs for patients and payers, ultimately generating greater profitability for providers.

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