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Katherine Capps
Katherine Capps

By Katherine Capps, Co-Founder and Executive Director, GTMRx Institute

May 3, 2019

I was thrilled to see HHS and CMS take a big step towards health care transformation with the announcement of the CMS Primary Cares Initiative—a new set of value-based care models that will be tested starting as early as January 2020. HHS Secretary Azar perhaps said it best—“For years, policymakers have talked about building an American health care system that focuses on primary care, pays for value, and places the patient at the center. These new models represent the biggest step ever taken toward that vision.”

Value-based care can be a critical means of achieving appropriate and personalized use of medication and gene therapies, the vision of the GTMRx Institute. Movement to value-based payment creates an immediate opportunity to support evidence-based solutions and transform practice by implementing practice models that support broad adoption of Comprehensive Medication Management (CMM).

When the primary care provider is able to be the “quarterback” of a centralized care team and access resources as needed, he or she can consult a pharmacist to assist and review a patient’s medications further upstream before the actual prescription is written. This approach has been proven successful—for instance, the VA’s use of clinical pharmacy specialists (CPS) for medication management services has been found to save time for physicians, improve efficiency and increase the value of care. Dr. Carolyn Clancy, Deputy Under Secretary for Discovery, Education and Affiliate Networks at the VA, said this about the program: “The CPS is a valuable member of the health care team who improves our capacity to provide timely, efficient, effective, and safe primary and specialty care, which sig­nificantly improves patients’ access to care. We urge other organizations to adopt a similar approach to fully optimize the use of their pharmacist providers into team-based models of care to ensure that patients have access to their medication expertise and services.” Looking at achieving clinical outcomes in a holistic and comprehensive manner allows this critical question to surface naturally: is THIS the right medication for THIS person?

Our founding board member Paul Grundy, MD, MPH, FACOEM, FACPM, chief transformation officer at Innovaccer, is a pioneer in team-based primary care.  Known as the “godfather” of the patient-centered medical home movement, his work with the Patient-Centered Primary Care Collaborative (PCPCC) laid the important groundwork that was required to make an announcement like this possible. “A personalized, patient-centered system and a coordinated approach to medications would dramatically improve outcomes, reduce overall costs and improve people’s lives,” he said in a statement to GTMRx. “We’re going down a road where if there’s no outcome, there’s no income. The easiest way to impact outcomes is get the medications right. Health care is a team sport. Physicians should be focusing on just two things: difficult diagnostic dilemmas and relationships. I see a huge uptick in quality of care when there’s a clinical pharmacist on the team.”  This CMS Initiative gives primary care the financial flexibility they need to make this a reality.

Along with improving patient outcomes, value-based care models can put primary care providers in a position to look at costs associated with managing multiple chronic conditions. While value-based care and comprehensive medication management are both associated with lowering health care costs, CMS and others evaluating this initiative must take a long-term view for true financial evaluation. Some of the savings generated by these models may take some time to materialize as preventable complications from chronic diseases or wrong medications often present in the form of hospital readmissions, excessive emergency room visits or long-term care stays that aren’t easily tied to the precipitating event.

When reimbursement is shifted from fee-for-service to global payments, primary care providers will be in a better position to provide more holistic care. It should be logical that this includes providing comprehensive medication management services that consider the importance of companion and complementary diagnostics to ensure a personalized approach to medication use to improve outcomes and reduce overall health care costs. If CMS sets up the reimbursement system appropriately and gives it time to work, the health care system will reap the benefits of the savings associated with this model and, more importantly, patients will receive higher quality of care and better outcomes.

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