Value-Based Payment Programs in Healthcare and Pharmacies

This report is a comprehensive examination of value-based payment (VBP) programs in healthcare, with a specific focus on their application within pharmacy services. It outlines the theory behind VBP, which aims to incentivize healthcare providers based on the quality and value of care rather than the volume of services delivered. The report summarizes the current state of VBP in healthcare, detailing its effectiveness and the lessons learned from various implementations. It also discusses the specific measures used in pharmacy VBP, including recent changes to pharmacy direct and indirect remuneration (DIR) in the Medicare Part D program. The report highlights the impact of performance measures on clinical outcomes and identifies opportunities and challenges for the evolution of pharmacy VBP. The findings are based on a literature review, key informant interviews, and analysis of pharmacy-related performance measures in Medicare and Medicaid public reporting programs. Recommendations for enhancing pharmacy VBP are also provided.