It’s easy today to be jaded and cynical about healthcare. From the patient’s perspective, it’s frustrating, costly, bureaucratic, and overly complex. There is a lot of discussion about ‘experience’, but very little progress is actually meaningful.
But healthcare is too important to accept the status quo. We can and should do better.
Abarca recently brought together visionaries from across the industry to discuss what healthcare will look like in 2030. I haven’t underestimated the level of difficulty required to achieve a drastic change, but I have found a little new hope. Below are three of his ideas that emerged from the session.
A revolution that starts with a prescription
By 2030, healthcare will catch up with other consumer services, providing seamless, personalized, convenient and affordable experiences to meet the needs of individuals rather than mere members of a collective.
This will require a revolution within the system, starting with the part of healthcare consumers most often experience: prescriptions. Establishing a path forward in all aspects of healthcare by setting prescriptive standards that improve member access, outcomes and experiences. It also makes it convenient and affordable.
Pharmacy Benefit Managers (PBMs) will cease to exist as we know them
By 2030, there will be no standalone PBMs. Instead, PBMs become payer extensions with deeply integrated technology, services, and branding. We call this model “virtual vertical integration”.
This paradigm eliminates the need to discuss transparency. Their business functions are so deeply intertwined that it is nearly impossible to operate without complete transparency.
Goodbye to dependency rebates
The industry will eventually move beyond the distinction between net and gross drug costs. Gone are the days of planning relying on rebates and premium subsidies as a source of income.
The only price that matters is what the member pays for the drug. This can be achieved if transactions are processed in a manner that preserves the confidentiality of the payer’s strategy. It is also supported by sophisticated value-based pricing with pharmaceutical manufacturers.
We understand these are ambitious ideas, but they are not out of our reach. A better healthcare ecosystem is only possible when PBMs, regulators, plan sponsors, pharmaceutical companies and providers work together.
And the first step is to establish trust across and within these entities, not just the patients who count on us. Hmm. Now let’s get down to business.
About the author
Jason Borschow is the President and CEO of Abarca.
