Considerations for Transitioning to a Value-Based Care System

When Robert Navarro, PharmD, started his career decades ago at a managed care company, health care as a percentage of the gross domestic product was 8% and at the time, he said, people were adamant the figure could not rise any higher.

Now, the University of Florida College of Pharmacy clinical professor noted the figure is at nearly 18% and rising, and the industry keeps having a conversation about value­. Speaking at the Academy of Managed Care Pharmacy's (AMCP)’s Managed Care & Specialty Pharmacy Annual Meeting, held April 23-26, in Boston, Massachusetts, he and Ashok Vegesna, PharmD, MS, of Novartis, spoke about Visions of a Value-Based Health Care System.

Before arriving at his proposals for a value-based health care system, Navarro encouraged his audience to think deeply about the issues affecting their businesses.

“Are you in the health care business or the health insurance business?” asked Navarro, one of the founders of AMCP. That was just one of many of the existential questions he asked about the role of value in population health and managed care before suggesting his view on how the issue should be approached.

For one thing, he asked, who decides the question of value? And depending on who is answering, can interests be aligned among payers, CMS, health care providers, patients, and society?

What if patients base their decisions on value? Would their decisions (for example, plans with no co-pays and deductibles, plans that cover all drugs) be considered good for value? Only a minority of patients consider value in terms of economic terms, he noted.

Click to continue reading on The American Journal of Managed Care.