Brenden O’Hara, RPh, BCACP, from Blue Cross Blue Shield of North Carolina, talked about the pharmacist’s role in improving outcomes in value-based contracts and why collaboration is needed.
Brenden O’Hara, RPh, BCACP, is a clinical pharmacist in Provider Engagement Initiatives at Blue Cross Blue Shield of North Carolina.
How can pharmacists improve outcomes in value-based contracts, particularly in the use of specialty therapies?
O’Hara: Lots of different ways. So, what we do in working with our pharmacists is understanding what their day entails and what their work is already doing, and then help support them with data and information and additional views of some of the members that would have that direct desired outcome—direct potential cost of care and different quality improvement outcomes. We share that information with our partners.
Specialty is definitely a big focus. We're not having many of our chronic disease state medications coming out. It's all going to be these specialty medications at high costs. We must pay attention to these high cost drivers and look for alternatives. Sometimes there's just not alternatives and it's just accepting that this is going to be a high-cost patient, high-cost therapy, but looking for other areas for opportunities to help control costs for those members.
Ideally, across the board, you're trying to control them, but sometimes you can't. If it's a cancer patient or a patient with cystic fibrosis, with some very unique disease states, if you meet all the criteria, there's not much to do. The medications are fantastic, and they do a great job at helping manage the disease state. So, you might look at other areas that you actually have the potential for impact.
Why is it important for collaboration to happen between health plans and pharmacists for value-based contracts?
O’Hara: A lot of the work is already happening in each individual area. So, there's a lot that health plans are doing to help manage cost of care and identify opportunities for savings. Health systems are doing it as well, whether that be for making sure that patients are on the right medications and adherent to it and improving outcomes and decreasing disease state burdens or [emergency department] visits.
But since we're doing it separately and now we have an opportunity with value-based contracts, together we win. So, if I can collaborate with health systems or different practitioners in different areas and help them save money, the health plan saves money and, together, we share those savings. That's the whole purpose of these value-based contracts.
So, the collaboration is a lot about the relationship building, but it's [also about] understanding that we're already doing this work individually and how do we do it together. How do we understand what each individual is doing and do the work together to have synergistic effects and higher-level effects by working together?