Value-Based Care: The New Normal

[V1] Initiation and Implementation of a Value-Based Contract in Medicaid: Challenges and Lessons Learned

ACPE UAN: 0233-0000-19-022-L04-P | Contact Hours: 1.25 | Activity Type: Knowledge-based

Faculty(s)

• 

  Terry Cothran, DPh

  Director
  Pharmacy Management Consultants
  Edmond, Oklahoma
• 

  Russell L. Knoth, PhD

  Director of Health Economics & Outcomes Research
  Eisai, Inc
  Orange, California

Moderator(s)

• HL

  Hannah Lee-Brown, PharmD

  Executive Fellow 2018-2019
  Pharmacy Quality Alliance
  Alexandria, Virginia

Prescription drug expenditures continue to increase, resulting in a larger portion of overall health care spending. With regards to Medicaid, comprehensive care must be provided to some of the most vulnerable individuals while operating under limited budgets and strict regulatory requirements. However, prescription drug value-based contracts have recently become a topic of interest in Medicaid, and the current health care landscape provides ample opportunity for savings and improving patient outcomes. The introduction of value-based payment arrangements in Medicaid has created the opportunity to learn about the challenges and hurdles of implementation.

This presentation will provide a manufacturer and payer (Medicaid) perspective on developing and implementing pharmacy based value-based contracts, including a discussion of barriers to initiation from both parties.

Learning Objectives:

At the completion of this activity, participants should be able to:

1. Examine the most productive approaches when working toward a value-based agreement.
2. Identify the data challenges based on the agreed upon measurements of the contract.
3. Explain how real-world evidence can be used to inform both the manufacturer and the payer on the value of the treatment under consideration for contracting.
4. Discuss the manufacturer and payer perspectives on value-based contracting, both challenges and advantages.