Insight

Perspectives from a payer-led pharmacy innovation lens

Healthcare trends have created opportunities to strategically target pharmacy to make innovative and transformative impact.

Jonathan Baker

Jonathan Baker

Principal, Health & Government Solutions, KPMG US

+1 404-844-9689

Saurabh Goyal

Saurabh Goyal

Advisory Managing Director, Health & Government Solutions, KPMG LLP

+1 857-284-3837

Healthcare costs continue to rise each year adding pressure for health organizations to become more innovative in new interventions to achieve the quadruple aim of healthcare. Rising costs of care are quickly felt in health payor organizations that continue to invest in technology-enabled, streamlined paths to improve access to quality health services. In response, many organizations have begun to evolve their pharmacy function from a siloed business unit into enterprise integrated clinical interventions and investment portfolios. Health organizations investment trends seem reluctant to slow down as members continue to receive care across multiple settings from home to hospital as medication management becomes more complex for members.

Four significant trends in the healthcare systems have created opportune circumstances to further target pharmacy as a strategic area of focus for healthcare companies to make innovative and transformative impacts across the healthcare market: increasing drug spend, transitions in care, aging population, and demand for convenience and digital self-management. To mitigate outcomes of these trends and keep pace with leading payor programs pharmacy interventions are being geared toward reducing member medication costs, improving data enabled processes, and focusing on convenience and access to pharmacy services. Payors must create holistic pharmacy intervention approaches that link various opportunities to support a member’s navigation through the healthcare system.

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