Using AI in the Era of Value-Based Care

Enter the era of value-based care.

In recent years, rising healthcare costs have prompted a shift from fee-for-service payment models to pay-for-performance, or “value-based,” reimbursement. Alternative payment models have transformed healthcare as we know it, with more payers reimbursing care providers, pharmacies, and pharmaceutical companies based on quality rather than quantity.

Learn about the impact of value-based care on pharmacies, payers, and pharma, plus how artificial intelligence (AI) can optimize value-based initiatives.

The Impact of Value-Based Care on Pharmacies, Payers, and Pharma

Value-based contracts have changed the game, incentivizing numerous healthcare organizations to address gaps in care, improve care quality, and achieve positive individual health outcomes. Here’s how value-based care impacts pharmacies, payers, and pharmaceutical companies alike:

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Pharmacies

Pharmacist-led value-based care initiatives play a key role in controlling healthcare costs, minimizing chronic disease burdens, and improving patient outcomes. Pharmacies can meet performance goals and maximize the return on investment (ROI) for value-based contracts by  identifying barriers to adherence, closing gaps in care, addressing potential safety concerns, and providing proactive medication management.

Health Plans and PBMs vs. Payers and PBMs

Payers and PBMs are on the other end of value-based contracting, with an increasing number of health plans adopting alternative payment models based on outcomes. Value-based care programs provide significant benefits for payers, reducing the overall costs of care, improving plan performance year over year, and enhancing the entire patient experience.

Pharmaceutical Companies

Like pharmacies and physicians, pharmaceutical companies are also involved in risk-sharing agreements with payers. These arrangements have encouraged more pharma companies to introduce patient support programs designed to properly educate patients, reduce barriers to adherence, and achieve better health outcomes.

Embracing AI Technology to Enhance Value-Based Care Initiatives

How can healthcare organizations embrace value-based care and achieve their goals? AI is the answer. AI technology leverages robust, varied datasets to make predictions. These datasets are pulled from a range of sources, including social determinants of health (SDOH), medical and pharmacy claims, historical engagement data, consumer behaviors, and more.

AI-powered predictions empower pharmacies, payers, and pharma companies to:

Target high-risk patients in need of support.

Using AI, healthcare organizations can accurately predict which patients have the highest risk of becoming non-adherent or experiencing a similar gap in care. Additionally, AI technology can hone in on patients who are most likely to be positively influenced by an intervention to achieve optimal results.

By investing in AI, organizations can effectively target and engage the right patients, which directly contributes to cost-savings and progress toward meeting performance goals and maximizing performance-based reimbursements.

Deploy personalized, cost-effective interventions.

With a better idea of who to target, interventions are sure to be more effective—but that’s not where the AI benefits end. Healthcare organizations can also turn to AI to personalize patient interventions and achieve optimal results at a lower overall cost.

AI can personalize patient interventions based on the ideal channel, messaging, and timing for each individual. For example, some patients may need high-touch interventions, whereas others may benefit just as much from low-touch interactions.

Optimizing Value-Based Programs with AllazoHealth’s AI Engine

Whether you’re a payer trying to maximize the cost-efficiency of your strategic initiatives or a pharmacy or pharmaceutical company investing in patient support programs to meet pay-for-performance measures, AI can help.

Numerous pharmacies, payers, and pharma companies use AllazoHealth’s AI engine to optimize patient support programs and enable effective, personalized interventions that improve health outcomes. Schedule a demo to see how AllazoHealth’s AI engine can maximize your value-based performance.

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