Dr Ashley Pappas Discusses Collaboration Between Academic Centers and Payers

The endgame for both the health system and the payer is always the patient, so we try to focus on treating patients in the most cost-effective manner with the most clinically appropriate evidence-based approach, explained Ashley Pappas, PharmD, MHA, assistant director of pharmacy, University of North Carolina Hospitals.

The endgame for both the health system and the payer is always the patient, so we try to focus on treating patients in the most cost-effective manner with the most clinically appropriate evidence-based approach, explained Ashley Pappas, PharmD, MHA, assistant director of pharmacy, University of North Carolina Hospitals.

Transcript

How important is a strong collaboration between an academic center and a payer?

So, I think the importance is collaboration. The endgame for both the health system and the payer is always the patient, and so we try to focus on treating patients in the most cost-effective manner with the most clinically appropriate evidence-based approach. So, collaborating with payers on kind of our structure at getting there is critical for patient outcomes.

What’s an example of a collaboration an academic center and a payer can initiate?

I think value-based contracting is a great example. I think it’s largely untapped by health systems and payers since most value-based contracting is being done with pharmacy benefit managers as well as payers and manufactures. I think just exploring the opportunity with payers and manufacturers combined to identify what can we set up with a health system. We know that our providers and our pharmacists provide value to patients. We know that patient outcomes are improved and we’re able to keep them in the system. So, figuring out how to do so and how to structure value-based payment models for health systems is a significant opportunity that is wholly untapped.

How do patient and financial outcomes benefit from this collaboration?

As we know, patient outcomes are improved if we are able to keep patients in the system. So, I think open lines of communication, communication channels, and collaboration opportunities with payers to help identify shared initiatives, as well as share what sort of issues both sides are facing, if nothing else just to keep the patient in the system, so they’re not lost to follow-up, can improve patient outcomes and improve cost savings as well.

Similarly, if we can keep patients in the system, decrease readmissions, keep patients healthy, that will ultimately improve finical outcomes. Another opportunity is to collaborate on development of care pathways so that both the payer and the health system come to the table to decide what is the most cost-effective manner to treat these patients to improve outcomes but keeping kind of finances at a reasonable cost.