Policy & Regulation News

Emerging Managed Care Pharmacy Trends Impact Patients, Payers

By Ryan Mcaskill

- On October 9, the Academy of Managed Care Pharmacy (AMCP) Foundation released a new study that examines emerging trends in the shifting health care market. The “Ahead of the Curve: Top 10 Emerging Health Care Trends – Implications for Patients, Providers, Payers and Pharmaceuticals” is the culmination of a six-month research initiative involving targeted literature and an advisory panel made up of thought leaders from academia, industry, managed care, government and patient advocacy.

The Patient Protection and Affordable Care Act (ACA) jump started health care system evolution by placing the “Triple Aim” at the center of any transformation. This emphasizes the importance of: (1) improving patient satisfaction and quality of care; (2) improved population health; and (3) affordability.

“In this fast paced environment, it is critical to understand the shifting landscape so that organizations can anticipate changes and prioritize actions,” David Moules, a Vice President of Pfizer, a partner in the survey, said in a release. “The results of ‘Ahead of the Curve’ validates the biopharmaceutical industry’s efforts to discover, develop and bring to market medicines deemed to be of value to the health care system including those that are responsible for paying for the medicines.”

The report uncovered 10 emerging trends that are going to impact managed care pharmacy organizations over the next five years. They include:

  • Post-Acute Care Costs by Market Affect Bundled Payment Models
  • How Morgan Health is Paving the Way for Advanced Primary Care
  • Healthcare Costs Concerns Impact Provider Rationing Behavior
  • Migration from fee-for-service to new provider payment models

    Increased cost pressures are driving payment models away from the popular fee-for-service models and towards systems that are more value-based with incentives for cost control and high-quality patient care.

    Consolidation of health care stakeholders

    Stakeholder consolidation, standardized decisions on care practices and pharmaceutical coverage and creating opportunities to evolve patient care practices is fueled by marketplace competition and payment uncertainty.

    Widespread use of data and analytics in patient care

    Adding data and analytics to patient care provides a strong opportunity to improve care. However, technology limitations, a lack of data exchange business models and broader organizational barriers are holding back the full potential of data-driven insights.

    Increased utilization and spending for specialty medicines

    Spending on specialty medicines will continue to increase. This forces payers and manufacturers to develop new approaches to formulary design and pricing practices that ensure patient access.

    Medicaid expansion

    Expansion will shift more economic risk from the government to payers and providers. This increases cost pressures across stakeholders and drives the creation of new, innovative models of care delivery that improves efficiency while maintaining quality.

    Migration to value-oriented health care marketplace

    Value-based models for benefit design and provider reimbursement grows as new approaches to balancing care quality and cost incentivizing use of optimal services. However, the creation of consistent definitions and benchmark metrics are needed.

    Growth and performance of accountable care organizations

    The accountable care organization (ACO) model is expanding with the expectations that its integrated delivery design and dual focus on care coordination and cost outcomes can drive efficiency. However a greater investment is data infrastructure is required.

    Greater patient engagement through technology

    New technologies are having a major impact across the health care landscape for managing and coordinating care. However, increased data transparency, patient education and coordination of tools are a must.

    Increasing patient cost-sharing

    Employers and managed care plans are increasing costs in an effort to curtail costs and incentivize patient involvement. This requires proper design, monitoring and patient empowerment to ensure it does not turn a corner and become a negative impact on access and adherence.

    Health care everywhere through new tools and mobile applications.

    Mobile is growing in popularity and is a new avenue for patient engagement and creating additional ways to deliver health care. The home is playing a larger role and mobile offers a way to monitor patient health when away from a physician or hospital.