Value-Based Care Medication Refill Request Form

Streamline Medication Refills in Value-Based Care Settings

This Value-Based Care Medication Refill Request Form is specifically designed for healthcare organizations operating under accountable care models, bundled payment arrangements, and quality-focused reimbursement structures. Whether you're a primary care practice, specialty clinic, or part of an ACO network, this template helps you balance efficient medication management with the quality reporting and outcome tracking that value-based contracts demand.

Built for Modern Healthcare Delivery

Traditional refill processes often miss crucial opportunities to capture quality metrics, assess adherence barriers, and coordinate care across providers. This template bridges that gap by embedding clinical quality measures, patient-reported outcomes, and care coordination touchpoints directly into the refill workflow—turning a routine administrative task into a valuable clinical engagement opportunity.

What Makes This Template Essential for Value-Based Care

Quality Measure Integration: Capture medication adherence data, identify barriers to compliance, and track outcomes that feed directly into HEDIS, MIPS, and ACO quality reporting requirements.

Outcome-Based Pricing Support: Document clinical effectiveness, side effects, and patient satisfaction to support value-based payment models and demonstrate medication ROI.

Care Coordination: Identify patients who need pharmacist consultation, care management outreach, or specialist referral—ensuring refills trigger appropriate follow-up within your care team.

Patient Engagement: Simple, conversational questions help patients share concerns about cost, side effects, or adherence challenges that might otherwise go unreported until a crisis occurs.

Perfect for Healthcare Organizations That Need

This form is ideal for primary care practices, patient-centered medical homes (PCMH), accountable care organizations, specialty clinics, and integrated health systems that are measured on quality outcomes, cost efficiency, and patient satisfaction. It's particularly valuable for practices managing chronic conditions where medication adherence directly impacts quality metrics and shared savings arrangements.

With Paperform's conditional logic, responses automatically route to the right team member—pharmacists for consultation needs, care managers for adherence support, or providers for clinical concerns. Connect your submissions to your EHR, care management platform, or reporting tools using Stepper workflows to ensure refill requests trigger the full spectrum of care coordination activities your value-based contracts require.

Automation That Supports Quality Care

Use Stepper to automate follow-up workflows: send medication education materials, schedule adherence check-ins, flag high-risk patients for outreach, or update your registry for quality reporting. Integration with your pharmacy system, EHR, and patient engagement tools ensures every refill request contributes to both efficient medication management and improved population health outcomes.

Trusted by healthcare organizations focused on quality, outcomes, and patient-centered care, this template helps you deliver on the promise of value-based care—one prescription at a time.