Clinical Role - Payer

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Politicians on both sides of the aisle have long been debating key issues in modern health care, including rising drug prices, access to care, and national addiction rates. Despite some agreement on which issues are most pressing, arguments persist in how to address them heading into the 2020 presidential election.
 
Over the past 30 years, health plans have changed from primarily conventional health care coverage to alternatives such as health maintenance organizations and, most recently, high deductible health plans.
Per capita health spending for 160 million Americans in employer-sponsored health plans grew by 4.4% in 2018, marking the third consecutive year of growth above 4%.

 
A new economic analysis published in JAMA found that the implementation of reference pricing increased the percentage of prescriptions filled for the lower-priced drugs within each therapeutic class, while simultaneously increasing patient cost sharing and decreasing overall prices paid.
 
checklist
This week’s tip examines a comprehensive set of pharmacist-based interventions in acute care settings.
 
Study suggests that the ACA improved financial risk protection against medical bills for low-income adults.
Economic Burden
A discussion on the economic burden of treating chemotherapy-induced nausea and vomiting.
 
reimbursement
These changes would lower the beneficiary cost sharing on more expensive prescription drugs, promote the use of generic medications, and allow beneficiaries to know in advance and compare their out-of-pocket payments for different prescription drugs.
As the industry focuses more on value-based care, predictive modeling allows pharmacies to shift their services from a one-size-fits-all approach to a personalized, high-touch strategy.
Several viable models continue to emerge for addressing the unique challenges of payment and financing for innovative, durable, curative gene and cell therapies.
indicators
This Tip of the Week focuses on a study to evaluate pharmacy in the context of true patient outcomes, rather than on the structure and process measures often employed in such ratings programs.
Electronic health records and the data created are being used on multiple levels and continue to be a driving force for improving care and lowering health care costs.