Though 2023 just began, Abarca has its eyes on 2030.
Earlier this month, we convened a group of leaders from across healthcare to discuss the potential for a more seamless and personalized healthcare system in the US, and how we can get there, together.
After two days of spirited discussion, here’s what we predict:
A more holistic approach to patient care.
By 2030, healthcare data will have transformed patient care. Consumers will increasingly access care at locations outside of a traditional doctor’s office. Information will be available in real-time, which will inform decisions at the point of care and point of sale. And the firewalls between medical and prescription benefits will cease to exist.
Combined, these advancements will create a 360-degree profile of each consumer. This will facilitate seamless and personalized care, and a member experience superior to anything we have ever seen.
The government will continue to play a role. Just a different one.
Over the past two years, government attention on the PBM industry has intensified at both the state and federal levels. Just this month, the Senate held a hearing on industry practices. And landmark lawsuits are being heard in Oklahoma, and elsewhere.
And, in one of the most significant changes in federal healthcare law in recent years, the Inflation Reduction Act (IRA) now permits the Department of Health and Human Services (HHS) to negotiate prices for certain drugs covered under Medicare Part B and Part D.
And, while the full impact of these actions is still yet to be seen, one thing is clear: the government will continue to oversee and intervene in drug pricing and pharmacy benefits.
A new emphasis on the provider experience.
The past few years have created a new reality for healthcare providers. The role of pharmacists is evolving as they gain more authority and responsibility in patient care. At the same time, physician burnout is rampant as historic shortages persist.
Now more than ever, stakeholders from across the industry need to begin laying the foundation to support providers today, and for years to come. Implementing workflows for seamless e-prescribing, electronic prior authorizations, and real-time benefit checks are a great place to start–but a better experience for providers cannot exist until incentives are aligned across the continuum of care.
Health plans will be in the driver’s seat.
In response to growing consolidation by competing health plans that own captive PBMs, more health plans will increasingly adopt virtual PBM models to preserve their ability to differentiate and compete in the market. By taking select (or all) pharmacy benefit services in-house, payers will have more control of the benefit design, visibility of reporting, flexibility of partners, and aligned incentives while managing the total cost of care. They will also reduce their need to rely on PBMs owned by their health plan competitors.
A new kind of transparency.
This is a concept that we raised at Abarca Forward in 2022. But, as technology and business practices continue to evolve, it has never felt more attainable–or important. So, I will take this opportunity to reiterate: By 2030, relationships between PBMs and their partners will be so deeply intertwined that operating with anything but full transparency would be nearly impossible.
While there is a lot to be done to bring these predictions to fruition, a more seamless and personalized healthcare system may just be closer than we think.
Now let’s get to work.
This article was written by Javier Gonzalez, PharmD, Chief Growth and Commercial Officer at Abarca.