ASHP leadership conference: managed care survival skills

Pharmacy leaders:

Stay Nimble in Rapidly Changing Market

Managed care market dynamics are changing quickly, so pharmacy leaders need to be nimble and work with their managed care teams to maintain a competitive strategy, speakers said at the 2021 ASHP Conference for Pharmacy Leaders, held virtually.

Mega-mergers have affected the market, with payors such as UnitedHealth Group joining forces with or acquiring pharmacy benefit managers and pharmacies, said Paul Spencer, MBA, the vice president of managed care and revenue cycle for Froedtert Health, in Milwaukee. “I don’t see this trend abating,” Mr. Spencer said, noting these compa-

nies are likely to continue establishing more vertical arrangements to round out their continuum of care. Some of them are even referring to themselves as providers, he said.

It’s important to remember that when negotiating with these companies, with their deep pockets and broad reach, “they have a scale we do not.” These forces have pitted providers against payors to see who is going to emerge as the patient’s trusted advisor, and it’s not clear how it will play out, Mr. Spencer noted. There is more blurring of traditional provider–payor relationships.

He cited telehealth and artificial intelligence as other trends to watch, with the technologies spurring more interactions between patients and companies delivering or directing care. Providers have an advantage in being the legacy trusted advisor, but payors have an advantage in that they can direct where they will pay for care.

The landscape is changing fast, with the entry of private equity money to try to fix the problem of lowering costs of drugs through mail-order companies, said Philip Brummond, PharmD, FASHP, the chief pharmacy officer at Froedtert Health. Another trend is payors continuing the push to outpatient or home care as a major cost-saver.

To compete in these vertically integrated spaces, pharmacy leaders need to leverage their integrated delivery models, with access to electronic health records and patient data, Dr. Brummond said. How to use these data, how to determine what kind of therapy is needed for which patients, and how to get outcomes that pharmaceutical manufacturers and others expect are areas that are “incredibly important to spend time on,” he said. Highlight metrics such as the Net Promoter Score and patient testimonials, be wise in what you do versus what you outsource, and work to restore transparency by driving lower costs.

There’s no time better than now to start developing a strategic vision and plan, with an eye toward making pharmacy a central component, Dr. Brummond stressed. He added these tips: • Get buy-in from executive leaders.

Help them understand the value of pharmacy as it relates to managing costs and improving quality outcomes. • Align the pharmacy team around your strategy. • Evaluate where your team’s time is

spent, and what actions and outcomes are being achieved. • Make sure the pharmacy executive has influence at the executive table.

“It’s easier said than done,” he said. “But more and more people are [assuming] roles that have that influence, and health systems are seeing the value that pharmacy is bringing to the overall enterprise.”

—Karen Blum

The sources reported no relevant fi nancial disclosures.

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