For all the progress made in shifting the U.S. healthcare system toward value-based care, one of the most powerful levers for improving outcomes and reducing costs remains underused: medications.
Medications influence every dimension of health outcomes. They prevent disease progression, reduce hospitalizations, and determine whether chronic conditions stay controlled or spiral into costly complications. Yet, when most organizations talk about medication management, they focus narrowly on adherence or medication therapy management (MTM) programs. While those are important pieces of the puzzle, they only scratch the surface of what’s possible.
To truly achieve value-based care, health plans and providers must view medications not as a siloed metric, but as a holistic, dynamic driver of both quality and cost performance.
The Costly Gap in Today’s Approach
Medications account for approximately 18% of total healthcare spending, but their influence extends far beyond the pharmacy benefit. When medications are not optimized—whether through inappropriate prescribing, missed therapy opportunities, or unaddressed side effects—the downstream costs are enormous.
Research has shown that medication-related problems contribute to an estimated $528 billion in avoidable costs each year, much of it from preventable hospitalizations and emergency visits. These are precisely the outcomes value-based care models aim to reduce.
Yet, traditional adherence and MTM programs rarely go deep enough to uncover the underlying drivers of medication risk. They focus on whether a prescription is filled or if a pharmacist completes a one-time review—but they often miss the broader context: whether the medication is the right one, at the right dose, for the right patient, at the right time.
Without a more holistic view, opportunities to prevent costly utilization are lost.
Medications as the Core of Value-Based Care
Medications touch nearly every quality measure that defines success in value-based contracts—from blood pressure and diabetes control to readmission rates and total cost of care. Optimizing medication use can directly improve these outcomes and the performance metrics tied to them.
For example, better medication optimization has been shown to:
- Reduce hospital admissions and readmissions by preventing exacerbations of chronic conditions.
- Improve disease control metrics, such as HbA1c and blood pressure, which drive Star Ratings and quality bonus payments.
- Lower total cost of care by addressing risks before they result in emergency visits or inpatient stays.
When medications are managed comprehensively, they become one of the most effective—and scalable—ways to achieve the “triple aim” of healthcare: better outcomes, lower costs, and improved patient experience.
Beyond Adherence: A Holistic View of Medication Use
A holistic medication strategy looks beyond whether a member is taking their medications as prescribed. It examines the entire medication ecosystem surrounding each patient, including:
- Clinical appropriateness: Are all of the patient’s conditions treated optimally according to evidence-based guidelines?
- Interactions and duplications: Do any combinations create unnecessary risk or cost?
- Social and behavioral factors: Can the patient afford their medications? Do they understand how and why to take them?
- Care coordination: Are prescribers, pharmacists, and care managers aligned on one medication plan?
Addressing these questions requires advanced analytics, robust data integration, and clinical expertise to interpret and act on insights. AI-driven platforms can now aggregate medical, pharmacy, and social data to predict where medication risks will emerge and intervene proactively with personalized recommendations.
This approach transforms medication management from a box-checking exercise into a strategic enabler of value-based performance.
Unlocking the Full Value of Medications
The healthcare industry has made meaningful strides in quality measurement, care coordination, and population health. But until medications are viewed as central—not peripheral—to those efforts, the system will continue to miss one of the most direct levers for delivering value-based care.
When medications are optimized holistically, they do more than improve adherence—they prevent hospitalizations, enhance clinical outcomes, and drive measurable savings across populations.
In value-based care, every dollar counts and every outcome matters. It’s time to close the gap between what medications can do and how we manage them today.
Because when we get medications right, everything else in healthcare—from outcomes to costs— works better.
About Arine
Arine is a leading AI-powered medication optimization platform that improves patient outcomes and reduces healthcare costs by ensuring that patients receive the most effective and appropriate medications. By integrating advanced analytics with deep clinical expertise, Arine provides timely, personalized recommendations, enabling health plans and risk-based provider organizations to enhance medication safety, adherence, and effectiveness among their members. Learn more at arine.io.
