The health sector represents approximately 18% of the US economy, of this sector hospitals are the largest component. Today, hospitals are looking forward to cuts in reimbursement, changing attitudes toward quality of care, increased focus on readmissions and unnecessary admissions, health reform and new reimbursement models emerging such as Accountable Care Organizations and accountability for outcomes (clinical, satisfaction with care, financial).

Under the Budget Control Act of 2011, if either the Joint Select Committee on Deficit Reduction is unable to come up with required level of budgets cuts, or Congress fails to approve the recommendations of the committee, the Medicare program would be subject to a sequester of up to 2 percent, which according to a report by Tripp Umbach on the Negative Economic Impact of Cuts to Hospital Funding ,the projected cut top hospitals is approximately $41 billion from 2013 to 2021 (TrippUmbach, 2011). This means possible hospital closures, decreases in employees, and other cuts which can impact availability of care as well as the quality of care there are able to provide.

For years the connection between costs and quality of care have been overlooked for the most part, even though numerous studies indicate that spending more does not necessary lead to better outcomes. There is a growing belief that the key to improving health care while controlling costs is making clinicians and health care organizations accountable for care rendered which is the basis for the premise behind Accountable Care Organizations and Health Reform in the United States. With this said, we are seeing and will continue to see changes to the ways clinicians and health care organizations are reimbursed, increased accountability for outcomes and these tied to payment, as well as more transparency around patient care with the increase in use of information technology tools. We are also in the most significant debt crisis our country has ever seen, rising unemployment, Increasing numbers of persons on Medicaid, and people living longer with Medicare benefits. What is worrisome – will health care organizations be able to provide the quality of care desired with the significance of reductions in reimbursement to these organizations and will other insurers follow Medicare’s lead.

In summary, we all have a lot on our plate in the future but what is increasingly clear is one has to think out of the box, look into the ways information is tied together, how and where care is delivered and how data can be integrated and mined to look at trends and areas for improvement, as well as ways to save money and increase savings. The PHS 340B Program not only allows a covered entity to save money on administered medications, obtain savings on eligible prescriptions filled in a retail contracted 340b pharmacy, but through companies such as CaptureRx, these entities can also use this data to assist in measuring persistency/adherence, trends in prescribing among clinicians, measuring whether practice guidelines are being utilized, and by combining information from reporting on prescriptions filled with information on biomarkers, and other indicators to measure outcomes. The organizations that remain in the future will be visionary as well as savvy in piecing together programs which avail them of opportunities to improve their bottom line.

Author - Holly Russo
Holly E. Russo, RN, MSN, MS, ECS
Vice President Hospitals and Health Systems, Chief Clinical Officer

CaptureRX® delivers pharmacy benefits management, 340B, and GPO solutions to America’s hospitals and health centers. For more information, please visit

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