Susan Cantrell

Over the past two years, our health care system’s strengths and weaknesses have come into sharper focus. As our country continues to adapt to the new COVID-19 landscape — a feat largely made possible by effective vaccines and more recently, antiviral treatment for patients with COVID-19 — the medical community can focus on addressing and solving the pitfalls highlighted during the pandemic. I believe our collective response to COVID-19 will leave us with a better understanding of the hardship many people face in accessing health care, and I, along with the Academy of Managed Care Pharmacy, am committed to working in our space to find solutions to get more people access to care at a cost they can afford by addressing racial health disparities, examining solutions to value and access, and making sure the right people are part of the pharmacy benefit design process.

Addressing racial health disparities

While we’ve long believed health disparities exist due to race, ethnicity and socioeconomic factors that persist in accessing care and treatment, the COVID-19 pandemic brought these inequalities to the forefront. Early in the pandemic, we saw people with lower incomes and communities of color having the highest prevalence and death rates. Then, earlier this year, many of those same communities had limited early access to the vaccine, and today Black and Hispanic populations are still vaccinating at a lower rate than the general population. We are committed to working toward solutions that address disparities in medication access and use, including increasing diversity and equity in formulary development and evaluating systems through a lens of promoting equity.

Closing gaps in data

One gap that we have uncovered quickly and we all knew existed is around data — including how it is collected, how it is stored and how it is shared within the health care community. It is difficult to address a problem or improve a problem if we do not have data that helps us measure success. In some cases, we simply do not have data on race and ethnicity that health plan and pharmacy benefit managers need to address this data gap. Gathering, standardizing and analyzing data on the health of marginalized communities and establishing the trust that enables our success in this process is vital to the work the medical community can do that will lead to meaningful change. This will enable us to examine this data in the way that we do for so many other things.

Focusing on value-based contracting

One of the most promising areas of focus is the shift from traditional payment to new value-based contracts for high-investment therapies. A value-based contract (VBC) is a written contractual agreement that establishes payment terms for medications or other health care technologies in relation to agreed-upon clinical circumstances, patient outcomes or measures with the goal of ensuring that innovations are used appropriately in the right patients. The increase in use of value-based contracting has been beneficial in terms of pointing to tangible probabilities of positive outcomes and in helping to justify pharmaceutical costs, because the amount paid ultimately relates to the value a product provides. In addition, there is an increase in alternative payment models that tie payment to different metrics and spread costs for high-investment therapies over time.

Relying on emerging technologies

Technological advancements and the amount of data that is available to us now and in the future will allow us to look at how we do things and assess, almost in real time, the impacts of the work that we’re doing or the use of a particular product such as tracking the impact of digital therapeutics and their patient population. Digital therapeutics will deliver data back to us on patient adherence and, depending on the product, patient outcomes. A big game changer for managed care pharmacy will be our continued use of and ability to access large sets of data to inform the work that we do, allowing us to better determine what products we should use and how to best leverage the tools that we have available to us.

The outlook for health care in 2022 is filled with promise and opportunity to improve a system that has saved countless lives in the past but has also let far too many slip through the cracks. And with the clarity gained since March 2020, I know that the health care landscape can change at a moment’s notice and that our focus might need to be redirected for the greater good. I urge all my peers across the country to join AMCP in being agile, collaborative and compassionate in facing the new challenges that arise, and to ensure that we always strive to improve patient care for all Americans.

Susan Cantrell is the CEO at Academy of Managed Care Pharmacy.