Habit #1: First things first: Value-based primary is the bedrock of the highest-functioning health systems
Value-based primary care stands in stark contrast to the milk-in-the-back-of-the-store primary care model that has been a pervasive driver of the scourge of over-treatment. Grassroots change at the city level is recognizing the importance of primary care and how it can attract major employers. IBM IBM +0.85% is a leading example of how wise organizations recognize that health benefits are the second biggest cost input into their business. Like any other item in their supply chain, they will shift to high-value suppliers. It turns out that locating jobs in high-value healthcare communities boils down to those communities with the strongest foundation of valued-based primary care.
Habit #2: Be proactive managing pharmacy benefits
Successful Rx management has been described as playing whack-a-mole. The pharmacy benefits management (PBM) industry has many firms that are well known for hidden fees, shell game pricing and taking drug manufacturers’ money to promote specific drugs.
There are three pillars to manage drug cost and quality:
- Review PBM arrangements to determine the “spread” (PBM profit) and whether more favorable terms are available.
- Formulary changes that create a large financial impact with next to no disruption.
- Carefully manage specialty drug acquisition and use.