Rx trends 2015: Partnering and risk sharing

 

NEW YORK — Partner up or risk being left behind. That’s the choice facing more and more pharmacy groups grappling with accountable care, outcomes-based reimbursement and risk-sharing collaborative health networks. 

 

With the ground shifting under their feet, pharmacy retailers are increasingly looking for new opportunities to link up with local health systems and physician networks in a continuum of care where providers share in the risks and rewards of improving wellness and preventing or successfully managing disease for millions of patients.

 

Health reform ushered in the era of accountable care organizations and accelerated the gradual shift to a new reimbursement model for physician, clinician and pharmacist-based health services. But even without the passage of the Accountable Care Act, cost-cutting imperatives made the rise of ACOs and risk-based integrated care models inevitable as managed care plans and health plan payers seek new ways to curb the nation’s spiraling, $2.8 trillion annual health bill.

 

Indeed, 21 of Fortune magazine’s top 50 U.S. companies have formed or joined healthcare partnerships that coordinate care among a network of health providers to boost patient outcomes and lower health costs for their employees, according to PricewaterhouseCoopers.

 

Reducing risk requires scrapping the traditional fee-for-service model of physician- and hospital-centered care focused on treating patients after they’ve gotten sick, and creating “a new kind of healthcare team,” composed of doctors, nurses, pharmacists, clinicians, health cost analysts and nutritionists “that surrounds and is part of that physician’s practice,” said David Kilgore, a physician and educator.