The escalating cost of health care is due to the combination of the increased prevalence of chronic diseases, high rates of poor disease control, and subsequent high utilization of acute care resources.
Cost is also significantly compounded by suboptimal medication use, estimated to be responsible for $528.4 billion in annual avoidable healthcare spending. This encompasses morbidity and mortality resulting from medications regiments that do not effectively treat the indicated medical problem and new medical problems that arise from medication misuse.
Comprehensive Medication Management
CRMC brings together clinical pharmacists, health systems and health plans to offer Comprehensive Medication Management (CMM) services for the highest risk and cost patient population. CMM is a standardized and evidence-based process to optimize drug therapy that is personalized for each patient in collaboration with physicians and health systems. Clinical pharmacists in the community are positioned as ancillary care providers to monitor and manage medication therapies. The desired outcome is to rapidly and safely attain treatment goals and prevent drug-related health expenditures. CMM closes the gap between available resources and services needed to ensure safe use of medications.
Population Health Strategy for Targeting High-Risk Patients
Ninety percent of chronic diseases require optimal medication use to achieve the best health outcomes possible. CMM services generate the greatest return on investment when provided to patients with chronic illnesses who are at highest risk for becoming medically complex or needing acute care services. In addition, patients with persistently uncontrolled chronic diseases and/or complex drug therapies benefit from CMM by having their conditions brought under control efficiently and safely.
Value-based Payment Models
As payment for healthcare services continues to shift from fee-for-service to value-based, the CRMC works with health plans and systems to develop and implement value-based payment models. These models are typically shared risk, where financial risk to payers are minimized through payments tied to patient health outcomes.
Cost of Prescription Drug–Related Morbidity and Mortality. Annals of Pharmacotherapy
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From a payer perspective, we want to support the collaborative as much as possible, so we really answer the question of what is the best way that we can provide optimal medication outcomes.
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Edward Jai, PharmD
Senior director, Pharmaceutical Services
Inland Empire Health Plan