Patient Self-Management Credentialing and Value-Based Health Benefits Design Considerations in Patient-Centered Team-Based Care

Introduction

Patient credentialing is a unique concept where the patient’s knowledge, skills, and performance associated with their chronic disease, lifestyle requirements, and therapy adherence strategies are assessed so health care providers can tailor education, support and care that effectively meets the specific needs of individual patients. The Patient Self-Management Credential (PSMC) is a psychometrically validated care resource that empowers health care providers and patients to work together in meaningful and efficient ways to identify and address areas for improvement in the self-management of health. With a progressive evidence-base that has evolved over the past 14 years, use of the PSMC has consistently produced patients that are more engaged and empowered to manage their own health care.

Convening a Consortium of Key Stakeholders

The APhA Foundation convened a consortium to further explore challenges within the current healthcare system as well as opportunities for potential system changes. The consortium provided insights and principles that could be used to guide institutions in making value-based health benefit decisions.

Perspectives from four key constituencies were considered:

1) patients who have been empowered by their providers through use of the PSMC,

2) practitioners who have utilized the PSMC in their practices to customize care,

3) payors who make data-driven decisions to inform their coverage, and

4) value-based health decision makers from benefit managers and health systems.

Recommendations from Consortium

A synthesis of the information, opinions, and expertise that emerged from the Consortium discussion produced six key themes that provided the basis for developing a principle-centered approach that will contribute to optimizing health and costs of care.

The Key Principles for Transforming the Delivery of Patient Care that could IMPACT effective health care system changes and improve patient outcomes are to:

Inspire patients, providers and payors to transform the health care system

Make the patient the center of all health care decisions

Promote access to evidence and information that elevates clinical decision-making

Align the incentives for patients, providers and payors

Cultivate quality improvement and practice enhancement

Take accountability for the financial, clinical and humanistic outcomes of patient medication use

The APhA Foundation will continue to work with system stakeholders to develop tools and resources that will guide stakeholders on “how” to translate these principles into practice and invent a preferred future for our health care delivery system.

Expert Panel Participants
Name	Title	Organization/Affiliation
Amanda Applegate	Pharmacy Clinical Services Coordinator	Balls Food Stores
Tery Baskin	President and CEO	RxResults
John Beckner	Senior Director, Strategic Initiatives	National Community Pharmacists Association
Dean Benton	Clinical Coordinator	Dillons Pharmacy
Benjamin Bluml	Senior Vice President, Research and Innovation	APhA Foundation
Kelly A. Brock	President	KB Pharmacy Solutions
Barry Bunting	National Practice Leader, Health Plan Innovation	Ateb
Mark Cziraky	Vice President of Research	HealthCore, Inc., an Anthem Company
John Forbes	Owner	Medicap Pharmacy
Scott Hamstra	Infectious Disease Specialist	U.S. Indian Health Service
Elizabeth K. Keyes	Executive Director	APhA Foundation
Sandra Leal	Vice President for Innovation	SinfoniaRx
Thomas Menighan	Executive Vice President and CEO	APhA
Shannon Peter	Clinical Pharmacy Manager	Think Whole Person Healthcare
Pete Sheldon	Vice President, Education & Patient Engagement	Med-IQ
Steve Simenson	Managing Partner	Goodrich Pharmacies
Jaan B. Skelton	President	Silver Pennies Consulting
Parisa Vatanka	Project Development Manager	APhA Foundation

Publication

White Paper

Patient Self-Management Credentialing and Value-Based Health Benefit Design Considerations in Patient-Centered, Team-Based Care

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