Legislative and Regulatory Trends

(L6) Alternative Payment Models: Real-World Examples from Managed Care Pharmacy

Thursday, March 23, 2023

4:30 PM – 5:45 PM

Location: 301AB

ACPE UAN:0233-0000-23-020-L04-P | Contact Hours: 1.25 | Activity Type: Knowledge-based

Faculty(s)

Galen W. Goertzen, PharmD BCACP (he/him/his)

Drug Education Coordinator - Clinical Pharmacy Services
Kaiser Permanente Washington
Spokane, WA
Ingrid L. Thieman, PharmD (she/her/hers)

Coordinator Clinical Pharmacy Programs
Kaiser Permanente Washington
Bellingham, WA

Moderator(s)

BS

Benjamin Schatzman, PharmD

Principal, US Strategy
Market Access Transformation
Yorba Linda, California

Alternative payment models (APMs), born from the payment reforms promoted by the Affordable Care Act, strive to increase health care provider accountability while improving patient quality and affordability. More than a decade later, the landscape of payment reform continues to evolve. There is a unique opportunity for pharmacists, particularly in managed care, to provide leadership and innovation through APMs that support quality of care while also managing drug costs. One integrated health plan will share three real-world examples from 2015-2021 to illustrate how managed care pharmacy can support APMs and discuss the successes and pitfalls of different models.

Learning Objectives::

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

Identify the four categories of the Alternative Payment Model Framework.
Identify at least two key stakeholders to advance pharmacy-shared savings models.
Describe three learnings from real-world alternative payment model examples.
Describe the next phase of innovation for pharmacy-driven alternative payment models.