It’s easy to be jaded and cynical about healthcare today. From the patient’s perspective, it’s frustrating, expensive, bureaucratic, and far too complex. From the point of view of someone in the business, incentives are misaligned, government regulations are byzantine, and, while there is much talk about “the patient experience,” in reality, little meaningful progress is being made in this area.
But healthcare is too important for us to accept the status quo. We can do better.
Abarca recently convened forward-thinking people across the industry to discuss what healthcare could be like in 2030. Although I do not underestimate the level of difficulty achieving bold change would take, I have a little new-found hope. The following are three of the ideas that came out of the session:
A revolution that will begin with prescriptions.
By 2030, healthcare will catch up to other consumer services and deliver a seamless and personalized experience, to meet the needs of individuals—not merely members of a population. It will also be convenient and affordable.
This will require a revolution within the system, beginning with prescriptions, the part of healthcare that consumers experience most often. By setting a standard for prescriptions that improves member access, outcomes, and experience, we will establish a path forward for every facet of healthcare.
PBMs will cease to exist as we know them.
By 2030, the standalone PBM will no longer exist. Instead, PBMs will become extensions of payers with deeply integrated technology, services, and brands. We call this model “virtual vertical integration.”
In this paradigm, there will no longer be a need to discuss transparency. Their business functions will be so deeply intertwined that operating with anything but full transparency would be nearly impossible.
A farewell to rebate dependencies.
The industry will finally move beyond the distinction between net and gross drug costs. Gone will be the days of plans relying on rebates as revenue sources or premium subsidies.
The only price that will matter is how much the member pays for a drug. This can be achieved when transactions are processed in a way that preserves the confidentiality of the payer’s strategy. Sophisticated value-based pricing arrangements with drug makers will also support it.
I understand that these are ambitious ideas, but they are not beyond our reach. However, a better healthcare ecosystem will only happen when PBMs, regulators, plan sponsors, pharma, and providers work together. And the first step is to establish trust across, and within, these entities, as well as with the patients who rely on us.
In fact, some might say these partnerships are already overdue. So, let’s get to work.
*This blog post was written by Jason Borschow, Founder & CEO at Abarca Health. It was originally published in Pharmacy Times.