Kaiser Permanente Pharmacist Outlines Key Challenges in Value-Based Care Implementation

Key Insights

• Kaiser Permanente's Tim Mok emphasizes the critical balance between patient outcomes, provider experience, and safety management in pharmacy decision-making processes.
• Real-world evidence plays a vital role in therapeutic decisions, though standardization of data collection methods remains a significant challenge in clinical practice.
• Rising medication costs have created a pressing need to educate healthcare teams about value-based care frameworks, as new therapies often show disproportionate cost increases relative to efficacy improvements.

In a recent Institute for Value-Based Medicine event in Seattle, Tim Mok, PharmD, BCPS, BCOP, from Kaiser Permanente shared insights on the evolving landscape of pharmacy decision-making in value-based care, highlighting the complex interplay between clinical outcomes and cost considerations.

Balancing Clinical Outcomes with Cost Management

Mok emphasized three crucial factors in pharmacy decision-making: patient outcomes and experience, provider expertise, and safety management. "We want to make sure that we're going to get the best clinical outcomes wherever possible, but also that patients aren't having any detriments to their life," Mok explained.

Provider experience with medications plays a vital role in building confidence across the healthcare team. This expertise enhances patient trust and ensures comprehensive care delivery. Safety management, particularly regarding side effects of new medications, requires careful consideration to prevent unnecessary emergency room visits and hospital admissions while managing costs effectively.

The Critical Role of Real-World Evidence

Real-world evidence has become increasingly important in pharmacy decision-making, particularly for newer therapeutics. Mok pointed out the limitations of FDA registry trials, noting that study populations often don't reflect the complexity of actual patients seen in clinical practice.

"Our registry trials that the FDA approves on is this perfect patient population. They don't necessarily have the comorbidities we see with the real-world patients," Mok stated. He advocated for better standardization of real-world evidence collection methods, acknowledging the current variations between retrospective and prospective approaches.

Challenges in Value-Based Care Transition

A significant challenge in transitioning to value-based care lies in education and cost communication. Modern healthcare economics have created scenarios where new therapies' cost increases often outpace their efficacy improvements. Mok illustrated this with a striking example: "A medication that comes out, although they may have an efficacy improvement of 20%, the cost is an increase of, like, 3 times."

This disproportionate relationship between cost and benefit necessitates careful consideration in treatment decisions. Healthcare teams must learn to incorporate cost considerations into clinical decision-making without compromising care quality. The transition requires a delicate balance between maintaining clinical excellence and acknowledging financial realities in modern healthcare delivery.