By setting a standard for prescriptions that improves member access, outcomes, and experience, we will establish a path forward for every facet of health care.
It’s easy to become jaded and cynical about health care today. From the patient’s perspective, it’s frustrating, expensive, bureaucratic, and far too complex. From the point of view of someone in the business, incentives are misaligned, government regulations are byzantine, and, although there is much talk about “the patient experience,” in reality, little meaningful progress is being made.
But health care is too important for us to accept the status quo. We can and must do better.
Abarca recently convened forward-thinking people from across the industry to discuss what health care could be like in 2030. Although I do not underestimate the level of difficulty achieving bold change would require, I have a little new found hope. The following are 3 of the ideas that came out of the session:
A revolution that will begin with prescriptions
By 2030, health care will catch up to other consumer services and deliver an experience that is both seamless and personalized—as well as convenient and affordable—to meet the needs of individuals, not merely members of a population.
This will require a revolution within the system, beginning with prescriptions, the part of health care that consumers experience most often. By setting a standard for prescriptions that improves member access, outcomes, and experience, we will establish a path forward for every facet of health care. It will also be convenient and affordable.
Pharmacy benefit managers (PBMs) will cease to exist as we know them
By 2030, the standalone PBM will no longer exist. Instead, PBMs will become extensions of payers with deeply integrated technology, services, and brands. We call this model “virtual vertical integration.”
In this paradigm, there will no longer be a need to discuss transparency. Their business functions will be so deeply intertwined that operating with anything but full transparency would be nearly impossible.
A farewell to rebate dependencies
The industry will—finally—move beyond the distinction between net and gross drug costs. Gone will be the days of plans relying on rebates as revenue sources or premium subsidies.
The only price that will matter is how much the member pays for a drug. This can be achieved when transactions are processed in a way that preserves the confidentiality of the payer’s strategy. It will also be supported by sophisticated value-based pricing arrangements with drug makers.
I understand that these are ambitious ideas, but they are not beyond our reach. A better health care ecosystem will only happen when PBMs, regulators, plan sponsors, pharma, and providers work together.
And the first step is to establish trust across, and within, these entities, in addition to the patients who rely on us. In fact, some might say that these partnerships are already overdue. So, let’s get to work.
About the Author
Jason Borschow, is president and CEO of Abarca.