Payment and Policy Solutions Workgroup
The purpose of this workgroup is to formulate and inform key policy and payment strategies to enable introduction and adoption of a systematic approach to medication use that optimizes clinical outcomes. Reductions in overall cost of care and improved outcomes will be realized by assuring access and affordability of innovative medications—for the right patients. Necessary to this goal will be activities to collect, evaluate and promote widespread (providers/systems, payers and patients) understanding, information sharing, and adoption of contemporary payment reform strategies and methods now occurring in U.S. health care (quality/safety/outcomes/value) and their logical alignment with and essential application to the provision of comprehensive medication management (CMM) services by teams of health care professionals across all settings of care. Model legislation, regulatory guidelines and benefit redesign strategies should be considered in all key areas including CMM implementation, streamlining of clinical trials, access to affordable medications (while preserving innovation), barriers to adoption, payment, clinical use of advanced diagnostics, and AI and IT analytics and data sharing, along with any other area which is necessary to promote a systematic approach to medication optimization.
Co-Lead: Kathy Pham, Pharm.D., BCPPS Director, Policy and Professional Affairs, ACCP
Co-Lead: Brad Cannon, Pharm.D., Director of Experiential Education, Assistant Professor, Department of Pharmacy Practice, Rosalind Franklin University
- Larry LaMotte, MPP, Principal, Advocacy Option LLC
Areas of Further Work
Create a Value Framework
- Identify evidence, promising payment frameworks, use case examples and tools for advocacy to promote the value of optimized medication use to consumers, providers, public & private sector payors
- Offer guidelines and proof points for advocacy that the CMM process offers to showcase and advocate on behalf of appropriate use, decreased waste and optimized outcomes.
Evaluate Barriers to Adoption of New Payment Models
- Evaluate and establish a plan to overcome policy and payment barriers that currently exist in the market preventing a scalable, sustainable rational system to optimize medication use and gene therapies
Determine Key Policy Elements
- Identify successful use cases (commercial, public, private) for use in advocacy and coalition building in support of and to advance the mission and vision of GTMRx
- Specifically define characteristics and foundational elements that will inform a policy platform designed to overcome barriers to broad
Identify Payment Solutions
- Identify payment structure solutions (and possible framework) necessary to overcome barriers to adoption of CMM and optimized use of medications and gene therapies.