Troy Trygstad, who’s the VP of pharmacy programs at CCNC, created a program called the Pharmacy Home Project when he and his team realized that pharmacists see patients almost 40 times a year, while patients visit PCPs fewer than 10 times a year. The takeaway was that pharmacists would be a formidable collaborator when added to a patient’s “medical neighborhood.” A true partner in the pursuit of global outcomes. Today I speak with Troy Trygstad about the Pharmacy Home Project and the evolving pharmacy model.

The same pressure that is being put on pharma companies by payers and employers is also being put on PBMs. With more price transparency and a focus on global outcomes and the overall cost of care, the days are numbered for PBMs to pad contracts and operate in a silo with little concern over the impact they’re having on medical costs. I speak with Lisa Erwin at Aventria Healthgroup about her other work directly with PBMs, PQA and others. We talk about PBMs and quality and how and why PBMs might open to collaboration.

Maybe a patient went into the hospital for a heart valve replacement and wound up with kidney failure and eventually died. The death would be attributed to cardiovascular causes and the kidney failure aspect may get lost. But what if it turned out that kidney failure was a common denominator of morbidity or mortality across multiple disease states? And what if said morbidity and mortality rates could be improved overall by focusing on improving kidney disease? Bill Heisel from IHME unravels this population health challenge in today’s episode.

Who is paying the pharmacy and setting the price the patient pays? Cash-paying patients aside, it’s going to be the insurance comapny that sets prices. And when I say insurance company, it is likely I don’t mean Aetna or United Health Care. These are medical carriers. The insurance company likely to pay the pharmacy and come up with the patient’s portion of the bill is called a PBM, a Pharmacy Benefit Manager. PBMs manage the pharmacy benefits for many patients, even those with a medical carrier. Today I speak with AJ Loiacano from Truveris.

Assess, Capture, Transform, Manage – these are the 4 steps to get from a practice built on an FFS payment model to one ready for pay for value. Today I speak with Tom Gregorio over at NJII – that would be the New Jersey Institute of Innovation. NJII recently received a CMS grant with the intent of helping practices make this change, helping them get from assess to capture to transform to manage.