Expect the continued rise of “payviders” this year. These are insurers that have bought or partnered with medical groups and other providers. “The line between providers and payers is getting blurrier and blurrier over the course of time with major payers taking significant positions in the provider space,” David Morlock, a managing director in Cain Brothers’ Health Systems M&A group, tells Modern Healthcare. Such arrangements typically involve global budgets—that means keeping patients out of the most expensive settings—e.g., hospitals. This, according to Modern Healthcare, makes payviders one of “many looming threats hospitals will face in 2021.” (Modern Healthcare*)
Evidence & Innovation
The Pharmacy Quality Alliance has named Micah Cost, PharmD, MS, as its CEO effective Feb. 1. Previously, he was executive director of the Tennessee Pharmacists Association. He’s also served as board president of the Alliance for Patient Medication Safety. PQA is a national quality organization that brings 250 organizations from across health care together to develop and implement quality measures, conduct research and provide education that supports better medication use and high-quality care. (Pharmacy Times)
AmerisourceBergen will pay $6.275 billion in cash and around 2 million shares of its common stock for the majority of Walgreens Boots Alliance’s wholesale business. The deal is expected to close by Sept. 30. The companies said the transaction will allow AmerisourceBergen to provide more global support to pharmacies and drugmakers and let Walgreens Boots Alliance focus on strengthening its retail pharmacy businesses. (pharmaphorum)
The administration has approved Tennessee’s Medicaid block grant plan, giving the state broader authority in running Medicaid in exchange for capping its annual federal funding, Kaiser Health News reports. Tennessee will be permitted to maintain a closed Medicaid formulary, which is the same approach to coverage taken by private health plans. Under the agreement, Tennessee’s annual funding cap will increase if enrollment grows. What’s different from other states is that federal Medicaid funding in Tennessee won’t automatically keep up with rising per-person Medicaid expenses. It’s unclear if the Biden administration will allow the move to stand. (KHN; STAT News)
CMS will require Medicare Part D prescription drug plans to enable technology that allows health care professionals to see at the point of care whether a drug they are prescribing is subject to prior authorization restrictions. The change will allow beneficiaries to receive their medication faster by decreasing the amount of time it takes to process prior authorizations, Healthcare Finance reports. Pharmacy benefit managers may begin implementing the new transaction standard now; compliance is required by Jan. 1, 2022. (Healthcare Finance)
Gopal Khanna has resigned as director of the Agency for Healthcare Research and Quality in response to the Jan. 6 riots at the Capitol. “As a first-generation American and a proud citizen of this country, nothing is more sacred than the values embedded in our Constitution, and the principles we hold dear. However, based on the horrific events last Wednesday at the nation’s Capitol, the very seat of our democracy and a beacon of freedom the world over, I have decided to step aside.” Dr. David Meyers, deputy director and chief physician at AHRQ, will serve as acting AHRQ director. (Modern Healthcare*)
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In Case You Missed It!
The Get The Medications Right Institute (GTMRx) workgroups have developed a set of Tools from Our Experts to advocate for medication management reform. These tools are designed to be useful resources for all stakeholders, and we believe these will be vital to optimize medication use through CMM in practice. We encourage you to share them, post them and use them to advocate for medication management reform. Find these guidance documents here.
Tools from our Experts Highlight | The Outcomes of Implementing and Integrating Comprehensive Medication Management in Team-Based Care: A Review of the Evidence on Quality, Access and Costs, October 2020
Learn about the peer-reviewed evidence showcasing the value of CMM, through improvements in access to care, provider work life, outcomes and patient satisfaction as well as a reduction in costs. These findings outline the CMM team-based care process that can be implemented in a variety of health care systems to ensure positive patient outcomes. Developed by the Evidence-Based Resources Subgroup of the Practice and Care Delivery Transformation Workgroup, read the document here.
ICYMI Blog: Marcia Buck, Pharm.D. & M. Shawn McFarland, Pharm.D. | CMM vs. MTM: Patient-focused process vs. medication-focused activity
Nearly 75% of primary care visits involve medication prescribing. It’s how we treat most conditions. But we still haven’t managed to get the medications right. Here’s the problem: Non-optimized medication therapy leads to more than 275,000 avoidable deaths each year, and it costs the nation over $528 billion annually. What do we mean by non-optimized medication therapy? It’s the misuse, underuse and overuse of medication therapy. People are dying because their medications are not being managed to ensure appropriate use. Read more here.
Hosted by the GTMRx Institute’s executive director and co-founder, Katherine H. Capps, Voices of Change features leaders who have knowledge, experience and ideas to solve this urgent need to get the medications right. Did you miss the most recent episode? Liz Helms discuss the patient’s perspective in getting the medications right, saying, “[Patients] need to ask the questions. We need to understand why we’re taking that, and if we’re taking multiple medicines, then we need to understand if they all work together. And if they don’t all work together, then there should be conversations [on] what should we do to change that?”
- Liz Helms, president and CEO of the California Chronic Care Coalition
- Liz Fowler, JD, Ph.D., executive vice president for programs, The Commonwealth Fund
- Amy Gutierrez, Pharm.D.,senior vice president and chief pharmacy officer, Kaiser Permanente
- Amanda Brummel, PharmD, BCACP, vice president, Clinical Ambulatory Pharmacy Services, Fairview Pharmacy Services
- Orsula V. Knowlton, PharmD, MBA, president and chief marketing & new business development officer, Tabula Rasa HealthCare
- Anand Parekh, MD, chief medical advisor, Bipartisan Policy Center
- Paul Grundy, MD, president, GTMRx; chief transformation officer, Innovaccer
AmazonSmile is an easy way for 0.5% of your qualified purchases go to the GTMRx Foundation at no cost to you. And signing up is simple—go to smile.amazon.com and select “Get the Medications Right Foundation” as your charity of choice. If you prefer to directly donate instead, you can do so here.
Adding the foundation on AmazonSmile will help us continue to provide no cost educational webinars, issue briefs, weekly news briefs and promote the need for transformation of our current system of medication use through social media campaigns.
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