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What Prescription Drug Pricing Can Learn From Value-Based Care Models

What Prescription Drug Pricing Can Learn From Value-Based Care Models

January 23, 2023Girisha FernandoMedCity NewsPharmacy Services

During this past year, momentum has increased to make healthcare more accessible and affordable: Highlights in the realm of increasing accessibility to affordable care and streamlining user experiences include Amazon acquiring primary healthcare provider One Medical; and Walmart inking a deal with UnitedHealth Group to provide care to Medicare Advantage patients at in-store clinics. And in the strongest government steps to date to reduce patient costs for prescription drugs, President Joe Biden signed into law the Inflation Reduction Act.

All of these developments are a move toward healthcare that is priced fairly for the value it delivers. In the technical sense, value-based care refers to U.S. health systems and providers receiving increased payments from health insurers and the government agency that oversees Medicare and Medicaid when patient outcomes meet or surpass certain goals—and decreased payments if patient outcome goals are not met. The model is based on paying for quality rather than quantity of services; and in many cases, care-providers and payers share at least part of the financial risk. Today between 6% and 15% of all healthcare revenue stems from value-based contracts. Although still a relatively small part of overall healthcare and with challenges of its own, it is one of the best answers to growing consumer demands for quality care at a fair price.

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