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Pay-for-Performance: How to Improve Patient Outcomes and Get Paid

Pay-for-Performance: How to Improve Patient Outcomes and Get Paid by Elements magazine | pbahealth.com


June 15, 2016


Patients’ outcomes are tied to more than just their health. Increasingly, key metrics are being used to determine how much your pharmacy gets paid. Improving your patients’ outcomes and your pharmacy’s metrics is essential to healthy patients and a healthy bottom line. But, it also raises some complicated questions.

Which metrics should your pharmacy focus on improving? What intervention will improve those metrics? Which patients would benefit from those interventions? And, how will you demonstrate your pharmacy’s value, so you can get paid for your performance?

You don’t have to answer those questions alone. MedHere Today™, a pharmacy quality and performance consulting group, can help your independent community pharmacy implement, grow and leverage adherence and quality initiatives to improve patients’ outcomes, get paid for your performance, and demonstrate your value to key health care partners.

Getting started

MedHere Today began as an adherence-monitoring program at L&S Pharmacy, an independent community pharmacy located in Charleston, Mo. After recognizing a need to expand beyond adherence, the owners transformed the program into a consulting company focused on driving quality in independent community pharmacies.

“We began with what we knew—adherence programs,” said Tripp Logan, Pharm.D., senior quality consultant at MedHere Today. “But the more we got involved with measure development at the Pharmacy Quality Alliance (PQA), talking to health systems and health plans, and working with state and national pharmacy organizations, the more we realized there’s more to it than adherence.”

He and his father, Richard Logan, Pharm.D., recognized a need to build high quality, high value pharmacies and pharmacy networks to support health care system partners, which are held accountable for measurably improving patients’ outcomes. Logan said MedHere Today helps pharmacies understand the health care system and its metrics, so pharmacies can improve patients’ outcomes with strategic interventions, lower overall health care costs and enhance their profitability.

The need to perform

Demonstrating your pharmacy’s value is essential in today’s marketplace, where there are more ways to measure performance than ever before.

Logan said pay-for-performance programs, comprehensive medication reviews (CMRs), and Medication Therapy Management (MTM) completion rates are only the beginning.

“These programs are typically just stepping stones for other things,” he said. Performance metrics are being used to categorize network pharmacy partners, and Logan said that scoring poorly could affect your business.

“Right or wrong, pharmacies are being held accountable for these prescription claims that drive adherence numbers,” he said. To improve those scores, Logan advises pharmacies to focus on targeting patients who register on health plans’ radar. By strategically improving key patients’ outcomes, Logan said pharmacies can improve their overall metrics.

“It’s so important for pharmacies to not only do well in pay-for-performance programs, but most of all, to understand who is measuring, what is being measured, and how to target patients that can positively impact those that are measuring,” he said.

How it works

Improving patients’ outcomes begins with selecting a metric to focus on.

Logan said MedHere Today starts by educating pharmacy owners, pharmacists, and non-pharmacist staff members about the metric they’re measuring, and the best practices and technology available to track that metric.

“Once we determine which metric to impact, we begin our initiative strategically focused on moving the needle on that measure,” Logan said. “We use this process whether it’s adherence monitoring, MTM, or helping create a pay-for-performance program.”

Next, MedHere Today helps pharmacies identify and engage patients whose individual outcomes could help improve the pharmacy’s overall performance on the selected measure. With help from MedHere Today’s data analytics, pharmacy reporting and regular consulting and communication, pharmacies develop strategies to incentivize and monitor these patients’ adherence metrics.

“MedHere Today helps pharmacies be perceived as the best possible partners for the health plans,” Logan said.

Once the process is in place, Logan said MedHere Today consultants help pharmacies repeat, revise and grow their adherence monitoring and care coordination programs.

“This process is slow in the beginning,” he said. “But when it’s successful, it blossoms into a streamlined revenue builder for the pharmacy and creates a building block for other value-based opportunities.”


 

Seeing results

MedHere Today™, a pharmacy quality and performance consulting group, doesn’t believe improving pharmacy quality is a one-size-fits-all approach.

“Our MedHere Today team’s customized approach has resulted in many measurable, and non-measurable, but equally important, benefits for our independent community pharmacy clients,” said Tripp Logan, Pharm.D., senior quality consultant at MedHere Today. Highlights of these results include:

 

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