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Accountable Care Organizations: What Impact on Pharma?

  • July 2015
  • -
  • Datamonitor Healthcare
  • -
  • 50 pages

The Affordable Care Act (ACA) passed in 2010 was the catalyst to a range of changes to the US healthcare system. Among the most important of these changes was how healthcare is paid for, with a number of ACA measures aimed at moving away from a fee-for-service reimbursement to payment of providers according to outcomes and quality of care. This shift from volume- to value-based reimbursement is captured most prominently in the establishment of Accountable Care Organizations (ACOs). ACOs are groups of doctors, hospitals, and other healthcare providers that share the risk, responsibility, and reward associated with delivering more cost-effective, higher-quality, and better-coordinated care. There are now over 700 ACOs in the US, spanning both the publicly funded Medicare and Medicaid, as well as the private sector.

The impact of this growing ACO movement on the pharma industry has so far been limited, but this is changing. Pharma firms have opportunities to engage with these restructured providers in new ways, including by helping to influence and set treatment best practice across different therapy areas, providing pharmacoeconomic and outcomes data, and potentially supporting a more prominent role for pharmacists within ACOs.

This report addresses the following questions:
- What are ACOs and how do they differ from other players in the US healthcare system?
- How is the role of medication management evolving within ACOs?
- What impact have ACOs had on the pharmaceutical market so far and how will that change in the future?
- What strategies for pharma-ACO engagement will be most successful?

Table Of Contents

Accountable Care Organizations: What Impact on Pharma?
EXECUTIVE SUMMARY
1. Affordable care, accountable care: should pharma care?, 2. ACOs come in many shapes and sizes, 3. ACOs, pharma, and medication management, 4. ACO results so far

AFFORDABLE CARE, ACCOUNTABLE CARE: SHOULD PHARMA CARE?
5. Payment reform: from volume to value, 6. Maturing, multiplying ACOs matter to pharma, 7. Key terms and players in value-based care, 8. Bibliography

ACOS COME IN MANY SHAPES AND SIZES
9. ACOs vary in structure, size, culture, and risk, 10. Variations on the ACO theme, 11. Winners and losers in a shifting, consolidating provider landscape, 12. Physician-led ACOs considered best for care, with health plan support, 13. Bibliography

ACOS, PHARMA, AND MEDICATION MANAGEMENT
14. Medication management is not a priority for most ACOs, 15. Some Medicare ACOs may be using more drugs, 16. Commercial ACOs' focus on short-term savings means drug cost caps, 17. Changing roles and incentives for physicians, 18. More formulary power to providers
19. ACO-pharma contracting? Not yet, but soon, 20. Pharmacists as the new physicians?, 21. Barriers to promoting pharmacists, 22.Pharma can help ACOs in other ways: data, education, and patient support, 23. Bibliography

ACO RESULTS SO FAR
24. Savings are modest, 25. Case study analysis: ACO success stories, 26. Bibliography

APPENDIX
27. About the author, 28. Scope, 29. Methodology

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