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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.


Kathy Pham headshot

Co-Lead: Kathy Pham, Pharm.D., BCPPS Director, Policy and Professional Affairs, ACCP


John McGlew headshot

Co-Lead: John McGlew, MA, Director of Government Affairs, ACCP


Co-Lead: Brad Cannon, Pharm.D., Director of Experiential Education, Assistant Professor, Department of Pharmacy Practice, Rosalind Franklin University


Co-Lead: Tom Kraus, JD, MHS, VP, Office of Government Relations, ASHP


Workgroup Participants

  • Larry LaMotte, MPP, Principal, Advocacy Option LLC

Areas of Further Work

Create a Value Framework

  1. 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.
    1. Identify outcomes CMM produces that deliver value for:
      1.  Payers
      2. Purchasers
      3. Providers
      4. Advocacy Groups
      5. Government Agencies
      6. Institutions
      7. Consumers
    2. Offer guidelines and proof points for advocacy that the CMM process offers to showcases and advocate on behalf of appropriate use, decreased waste and optimized outcomes.
    3. Offer guidance to inform contract standards and common definitions between those who buy care (consumers and employers) and those who contract for care (health plans, consumers, government).
    4. Potential tactics:
      1. Coordinate and conduct presentations and discussions with payer and clinical leaders.
      2. Conduct pilots to examine feasibility of CMM integration.

Evaluate Barriers to Adoption of New Payment Models

  1. 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.
    1. Potential tactics:
      1. Conduct interviews with systems that have incorporated CMM to document barriers and how/whether they were overcome.
      2. Examine current state and federal legislation related to optimize medication use and rapid adoption of innovative therapies aided by advances in diagnostics/ clinical trials streamlining along with CMM implementation.
      3. Examine the current policy and payment barriers related to evolving “outcomes-based agreements” (OBAs) VBC payment models for medications and the impact of CMM with access and utilization of CMM practice with companion/complementary diagnostics to impact care. Outline a framework/guidance for best practices for success of OBA’s for employers/payers/providers/plans.

Determine Key Policy Elements

  1. 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.
  2. Specifically define characteristics and foundational elements that will inform a policy  platform designed to overcome barriers to broad and sustainable adoption of team-based care activities designed to optimize the use of medication and gene therapies.
  3. Potential tactics:
    1. Define successful adoption of CMM:
      1. Individual practice & integrated systems economic, safety, resource savings, and outcomes data.
      2. Perceived as providing value to payers, patients and clinicians.
      3. Viewed as a model of excellence in team-based, patient-centered care.
      4. Able to be adopted at scale.
      5. Adaptable to different payment systems (e.g., public and private).

Identify Payment Solutions

  1. Identify payment structure solutions (and possible framework) necessary to overcome barriers to adoption of CMM and optimized use of medications and gene therapies.
    1. Potential tactics:
      1. Develop a summary (resource list) of existing evidence of CMM impact.
      2. Deploy evidence and develop use cases developed by Care Delivery and Transformation Workgroup to promote the value of optimized medication use to payers, consumers and providers; ensure this encompasses payer groups and self-insured employees.

Design an approach to educate and engage policymakers about these solutions

  1. Identify partners, develop tools, guidance and a dissemination plan (practice leaders, physicians/their agents, consultants, care teams and payors) to increase awareness, build demand for, and ensure adoption and use of a successful strategies and standardized implementation processes for CMM integration.
    1. Potential Tactics:
      1. Build awareness of existing private and public models in which CMM has successfully been implemented and delivered value as measured by different stakeholders.
      2. Share specific recommendations to encourage adoption of CMM with payers, policy makers, and influencers (e.g., PTAC).
      3. Deploy marketing tools developed by Care Delivery and Transformation Workgroup to engage patient advocacy and professional groups to move them to a full understanding of the economic and human toll resulting from non-optimized medication use.

Standing Date:

  • Every other Tuesday from 2:00-3:00 pm EST
  • 2019: 9/5, 9/17, 10/1, 10/15, 10/29, 11/12, 12/3, 12/10
  • 2020: 1/14, 1/22, 2/25, 3/24, 4/7, 4/21, 5/5, 5/19, 6/2, 6/16, 6/30, 7/14, 7/28

If interested in learning more about the Workgroup, contact:

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