Unfortunately, standard prescribing and prescription fulfillment practices are focused on volume of prescriptions over value. The result of these practices leads to circumstances of polypharmacy, low adherence to prescribed medications, and an increased risk for drug-drug interactions.
There is a strong push among physicians to transition to care models that incentivize fewer, more effective treatments. This same perspective should also be held in pharmacy.
We’re seeing enrollment in Special Needs Plans is increasing – up 32% over the last 10 years1 – meaning there are more people than ever with chronic illnesses joining long-term treatment plans. And over the next 10 years, there will be a projected 4.6 million medication-related hospitalizations of Americans 65+. Meanwhile, 67% of those Americans 65 years or older take 5+ meds a day2.
This isn’t just a problem for patients: medication misuse and over-prescribing practices are costing the country billions every year. A 2018 study estimated that the annual cost of drug-related morbidity and mortality resulting from non-optimized medication therapy was $528.4 billion3.
As we look to a post-pandemic healthcare system, improvements need to be made to remedy these concerns with focuses on barriers to optimal quality and cost.
Predictive analytics and robust patient data can mitigate some of these issues. Many patients are medically complex or on too many medications they don’t know how to use or that may pose a threat of interaction with other medications on the patient’s regimen. When we accumulate this data with a comprehensive list of the current and past medications a patient has been on, we can formulate the most effective medication regimens by quality and (where possible) cost to help patients get on and stay on the right medications.
The timing is right to advance care practices that support value-based care models—especially as we witness this increase in complex patients and see patients increasingly rely on their pharmacists to educate them about their medication regimens and disease states. At Mosaic, we have worked successfully with medically complex, socially vulnerable members and their prescribers to mitigate a wide range of SDoH and other barriers that prevent proper medication use and optimal health outcomes. We have seen that when we take time to provide services above and beyond traditional medication dispensing—interviewing patients to learn about their barriers to proper medication use, documenting social determinants of health (SDoH) and other factors negatively impacting their health, and coordinating with providers to address those barriers to quality care— we can meaningfully improve members’ medication use and, ultimately, their health outcomes. This is the purpose of value-based care.
A transition to value-based pharmacy is not only key to improving medication adherence, polypharmacy, and the rising costs of healthcare in this country, but integral to improving health at the community level. This is not a call to shift from traditional dispensing, but rather a push for more robust involvement among pharmacists to address the needs of more complex patients that may require these additional services.
By offering an additional level of care—and in turn, tackling SDoH and other longstanding barriers—we can help to ensure effective medication use. Value-based care that seeks to address social determinants of health is imperative if we are to address the challenges of improving the wellbeing of our patients and responding to the rising need for additional pharmacy support.