IMPROVING PATIENT ACCESS TO PRESCRIPTIONS

Alternative Payment Models Help Medicare Patients Get the Vital Services They Need to Stay Healthy

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 Evolent Care Partners operating in 12 states to help patients access the medications they need to manager their conditions.

For healthcare providers nationwide, this kind of patient assistance is only possible because of Medicare’s alternative payment model (APM) program.

Bob’s story:

Bob, a retired healthcare professional, was struggling with a serious lung condition. While there are drug options, Bob found only one to be effective. Unfortunately, that medication became nearly impossible to find during a nationwide shortage.

During his search for his prescription, Bob found one pharmacy that had a supply, but that pharmacy didn’t bill Medicare Part B. Desperate, Bob paid out-of-pocket—more than $1,000 for a one-month supply. But even that source dried up.

Bob knew that without the drug his condition would worsen, leading to decreased lung capacity and possibly hospitalization, and perhaps even death. He shared his concerns with his physician, who called in help from Becky, an experienced care advisor, to make sure Bob could access his prescription.

Becky’s persistent work helped Bob get the medication delivered right to his door at a cost of only $26.95 per month. Thanks to her, Bob had quick and affordable access to his critical medication.

Because value-based care focuses on outcomes, physicians participating in an organization like Evolent Care Partners can help patient access and afford their medications. Without Congress’ continued support for value-based models, patients like Bob may not get the support or care they need.

Download the PDF now.