Introduction

Specialty pharmacy is well-positioned to lead the healthcare industry in the shift towards value-based care. 

Niche but high in value, specialty pharmacy already implements the unified, patient-centric approach that is foundational to value-based models. With attention to a few key opportunities and challenges, specialty pharmacies can champion value-based care within and beyond their organizations.

Value-Based Care Overview

Although a universal definition and practice of value-based care is still lacking, the Centers for Medicare and Medicaid Services (CMS) define value-based care as a healthcare delivery model focused on quality of care, provider performance, and patient experience. 

The model emphasizes a more integrated approach wherein providers coordinate with each other, the patient, and across the health system to improve patient outcomes.

Importantly, value-based care also serves as a payment model for providers. In a value-based agreement, providers receive reimbursement for demonstrating improved patient outcomes. 

In other words, the “value” of a value-based care model is health outcomes relative to the cost of care. Value-based models differ from traditional fee-for-service models where pay is based on the number of services delivered. Read more >