It’s easy to be jaded and cynical about healthcare today, but we are actively working toward a New Era in Healthcare. From the patient’s perspective, the current system is often 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,” little meaningful progress is being made.
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 difficulty of achieving bold change, I have new-found hope. The following are three key ideas that define this upcoming New Era in Healthcare:
1. A Revolution That Begins with Prescriptions
By 2030, healthcare will catch up to other consumer services to deliver a seamless and personalized experience. The goal is to meet the needs of individuals—not merely members of a population—while ensuring care remains convenient and affordable.
This shift requires 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 and outcomes, we will establish a path forward for every facet of the industry.
2. PBMs Will Cease to Exist as We Know Them
The standalone PBM is part of the past. In this New Era in Healthcare, 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 as a separate goal. Business functions will be so deeply intertwined that operating with anything but full transparency would be nearly impossible.
3. 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 through:
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Transactions processed to preserve payer strategy confidentiality.
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Sophisticated value-based pricing arrangements with drug makers.
Building the Future Together
I understand that these are ambitious ideas, but they are within reach. However, a better healthcare ecosystem will only happen when PBMs, regulators, plan sponsors, pharma, and providers work together. The first step is to establish trust across these entities and 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.
About Abarca Health
At Abarca, we believe in an Unstoppable Drive for a Better Way. Our commitment to making healthcare seamless and personalized for all drives us to innovate in AI, specialty pharmacy, and predictive analytics. By transforming challenges into opportunities, we deliver PBM like no one else: better patient outcomes and an overall revolutionary healthcare experience. Join us in shaping the future at the intersection of technology and care!