HEALTHIER LIVING FOR ANNA WAS MADE POSSIBLE BY VALUE-BASED CARE
Alternative Payment Models Help Medicare Patients Afford Their Medications and Manage Chronic Conditions
Value-based care models pay hospitals and providers, in part, on the quality of services delivered and outcomes achieved. These models enable healthcare organizations like CHESS Health Solutions in Winston-Salem, North Carolina to help patients manage and afford multiple medications for chronic conditions.
For healthcare providers nationwide, this kind of personal care is only possible because of Medicare’s Alternative Payment Model (APM) program.
Anna’s story:
Anna was diagnosed with a new chronic condition after living with diabetes for five years. Managing her diabetes was already challenging enough given the price of her medication, and she was prescribed multiple medications for the newly diagnosed condition, which she could not afford.
After realizing that Anna’s second prescription was never filled, CHESS reached out to Anna to provide assistance. She told CHESS that she could not afford the prescription and was planning on not taking it, rather than following up with her doctor.
CHESS went to work for Anna – calling her primary care physician, working with Medicare to secure free trials for her prescriptions, and monitoring Anna to look for signs of improvement.
CHESS was able to call in a 30-day free trial for Anna’s blood thinner and helped her qualify for patient assistance programs. CHESS also helped Anna better manage her diabetes by switching her to a new medication completely covered by her insurance.
Anna now has the proper medication to manage her chronic illnesses and can continue to do the things she loves, like spending time with her grandchildren.
Because value-based care focuses on outcomes, healthcare organizations like CHESS use the incentive payments to support their patients in managing their conditions and affording their medications. Without continued support for value-based models, patients like Anna may not get the care they need.
This patient story has been de-identified to protect patient privacy consistent with HIPAA – no real patient names are referenced, while the experience described reflects actual events.