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Pharmacy’s role in bundled payments

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In a new series, Hospitals & Health Networks looks at the challenge of  hospitals developing long-term plans for the pharmacy piece of bundled payments.

The piece notes that the Affordable Care Act and other changes are “creating a perfect storm that virtually mandates a key role for hospital inpatient pharmacy in a health system’s or hospital’s clinical and financial decision making. Pharmacy, until recently (or in some cases, still) relegated to simply dispensing drugs from the basement, needs to find its way upstairs, unleashing its ability to manage chronic disease, reduce readmissions through rigorous medication reconciliation while a patient is in the hospital and be a team member that helps keep patients from returning to the hospital.”

“Bundled payment and other programs are going to change how we have to manage drugs across a health system,” Edward Choy, PharmD, president of health systems operations for CPS, told the news service.

H&HN noted: “Inpatient drugs used to be under formulary, while outpatient drugs were managed by private insurers and pharmacy benefit managers. Now, all drugs need to be managed under formulary. Finding the most cost-effective way to treat the patient becomes more of a priority.”

“Limiting readmissions has already been an impetus for change under value-based purchasing, but with bundled payment, the hospital or health system may find it is paying the entire cost of a readmission, ” H&HN noted.

“You don’t want to see a patient get readmitted because of some unavailable drug or a patient unable to afford that drug,” Mr. Choy said.

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