Policy Prescriptions Episode 3: Value-Based Care Explained | The Future of ACOs, Medicare & Healthcare Policy

In this episode of Policy Prescriptions, Gary Jacobs sits down with Aisha Pittman, Senior Vice President of Government Affairs at National Association of ACOs, and Ray Quintero, Managing Partner at Healthsperien, for a deep conversation about the future of healthcare policy, Medicare reform, and accountable care organizations (ACOs). They break down how value-based care works, why fee-for-service medicine creates problems, and how new models like ACO LEAD are reshaping the health care system.

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Action for Progress Launches a New National Commitment to Behavioral Health and Addiction Care

Former U.S. Representative Patrick J. Kennedy has been named as a Partner with the firm and will establish and lead a new national mental health and addiction policy practice. Rep. Kennedy will bring his decades of national leadership, advocacy, and expertise in mental health to advise a diverse array of clients, focusing on mental health and addiction, community-based services and supports, and the need for health system transformation.

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Employer Experiences Managing Prescription Drug Benefits and Partnerships with PBMs

Client

Pharmaceutical Care Management Association (PCMA)

Dates

November 2025 – March 2026

Employer Experiences Managing Prescription Drug Benefits and Partnerships with PBMs

Objectives

The Pharmaceutical Care Management Association (PCMA) commissioned Healthsperien to conduct a survey examining employer experiences with prescription drug benefit management and their relationships with pharmacy benefit managers (PBMs). The survey was designed to capture employer priorities when designing drug benefit programs, how employers evaluate PBM partnerships, and how employers perceive PBM performance across financial management, plan design, and additional services.

Approach

Healthsperien designed and implemented an employer survey to capture employer experiences managing prescription drug benefits and working with PBMs.

Healthsperien collaborated with PCMA to refine the survey instrument which focused on several key areas:  

  • Employer approaches to designing and managing prescription drug benefits
  • Employer priorities when selecting and contracting with PBMs
  • Employer satisfaction with PBM services, contracting structures, and financial performance
  • Employer experiences with rebates and drug benefit cost management
  • Employer perspectives on proposed PBM policy changes

Healthsperien then administered the survey, analyzed results, and summarized key findings in a comprehensive chart pack. The results of the survey provide a data-driven perspective on how employers evaluate PBM partnerships and the role PBMs play in helping organizations manage prescription drug benefits.

Results

Survey findings suggest that employers view themselves as informed decision-makers

Key survey findings include:

  • 95 percent

    of employers reported confidence in their organization’s ability to make decisions regarding prescription drug benefits.

  • 98 percent

    of employers said access to a wide network of pharmacies is an important factor when selecting a PBM.

  • 95 percent

    of employers reported satisfaction with the data, reporting, and analytics tools provided by their PBM.

  • 94 percent

    of employers reported satisfaction with the accessibility of pharmacy networks provided by their PBM.

  • 89 percent

    of employers that received rebates reported using them to lower employees’ out-of-pocket prescription drug costs.

Methodology and Study Limitations

The survey was conducted online by Healthsperien between January 9 and January 21, 2026, among 1,035 U.S. employers involved in decision-making or oversight of employee health benefits. Respondents were recruited through an online panel and were required to work for organizations that offer health insurance coverage and prescription drug benefits administered through a PBM. Recruiting from an online panel may introduce panel-specific biases. Individuals who participate in online panels may differ from the broader employer population in terms of engagement, digital literacy, or attitudes toward surveys.

Participants represented a range of industries and organization sizes and included human resources leaders, executive leadership, and other benefits decision-makers. It is important to note that the sample skews toward mid-size and large employers, whose experiences with PBMs may differ from smaller employers with fewer benefits management resources.

The 37-question web-based survey, accessible across devices, examined employer experiences with PBM contracting, drug benefit design, rebate use, and satisfaction with PBM services. Some questions were asked only of employers who contract directly with PBMs, resulting in varying base sizes across survey questions. Survey responses reflect self-reported employer perspectives, which may be influenced by recall bias or subjective perceptions. The study used a convenience sample and results were not weighted, meaning findings are reported as collected. The use of the convenience sample means results may not be fully representative of the broader population of employers.

Project materials

We’re proud to announce the Center for Health Research, Policy, & Strategy—Healthsperien’s Newest Center of Expertise.

Healthsperien announces the official launch of its Center for Health Research, Policy & Strategy, the newest addition to Healthsperien’s expanding capabilities and the third in a series of new Centers of Expertise. Serving as the firm’s hub for data-driven analysis, applied research, and evidence-informed policy development, the Center will provide clients with the objective insights needed to navigate today’s most complex healthcare decisions. By leveraging national administrative claims datasets, real-world evidence, surveys, focus groups, and interviews, the Center will deliver evidence-based strategies to inform and guide client decision-making.

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Redefining Hospice: Living Fully Until the End

A recent Forbes article highlights insights from Tom Koutsoumpas, Founder & President of Healthsperien and CEO & Founder of the National Partnership for Healthcare and Hospice Innovation (NPHI), who urges a redefinition of hospice—not as a last resort, but as a life-affirming opportunity for patients and families. From dispelling myths to embracing telehealth and advancing equity, Koutsoumpas emphasizes that hospice is about living fully, with dignity and support, until the very end.

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