Payment Model Idea

[Digsbe]

I was just thinking about this today, but what if how pharmacists are paid by insurance for drugs is changed to a more similar model to how hospitals/physicians are beginning to be paid? Much of healthcare is moving moreso towards quality based payment models with patient satisfaction, readmission rates, accountable care and focuses on improved quality coming about when it comes to determining payment. There are problems with patient reported surveys, but anyone in hospitals knows they are now impacting reimbursement.

Pharmacy as a profession is trying to advance in other areas when it comes to expanding scopes, addressing gaps in healthcare amid a PCP shortage like pharmacists managing chronic diseases and clinical pharmacy becoming more of a thing. However, it seems retail is trending to become less and less of a patient centered practice and more of a corporate based script pushing business where the main metric is how fast you can churn out a script, which discourages patient counselling or providing meaningful patient care. It's just human nature, businesses need to be profitable and there is nothing wrong with that. However, profit seems to come at the expense of care which is the primary goal of pharmacy practice.

What if reimbursement models changed to be focused on the quality of care a pharmacist may provide? What if a refined form of a patient satisfaction survey, or "secret shopper" type patients could evaluate how well and thoroughly a pharmacist counsels a patient on medications and have that impact what you get paid by the insurance companies? MTM is a thing, it's not the boom people anticipated it to be but the fact that it exists and is still alive is because some insurance plans recognize how proper counselling and extensive medication therapy review can save them money and improve health. In the inpatient setting I've increasingly seen hospitals wanting pharmacy more involved in patient discharge counselling to reduce readmission rates, improve patient satisfaction as well as providing overall better care by instructing and educating patients and their caregivers on the medications they'll be sent home on or how to manage their disease/recovery. What if in retail quality metrics were incorporated into payment? One may argue it saves the insurance company money in the long run if their patients know how to properly use their chronic medications or at least understand why they need them. If they pay less in hospital bills they may be willing to pay more in dispensing fees. Many pharmacists will pass the poor excuse of "counselling" by saying "just take one everyday" or "take it with food" or just literally a sentence on the medication in a half-assed attitude and during MTM's I've done people have had no clue about their medications even though they were supposedly "counselled" on it as per legal requirements.

I think this may be a good thing for the retail profession. Bad pharmacists who don't provide quality care and can't counsel to save their life shouldn't have a job, or at least shouldn't have similar marketing value compared to someone who does care and does properly counsel. The primary metric shouldn't be script speed at the expense of counselling or providing patient care services. In the current model, and where pharmacy appears to be going in retail, seems to actually discourage providing quality care because it just doesn't make any money (which is understandable). I think if individual pharmacists could market how well they as an individual perform when it comes to providing care and pharmacies that perform better in that aspect getting better pay like hospitals with lower readmissions and higher satisfaction scores that this may be a good thing for the largest sector of pharmacy (retail). Basically, I think payers should consider and adopt quality measures behind reimbursement for drugs and I think this would most importantly improve patient care, but also possibly evolve how retail pharmacy is practiced with less emphasis on speed and churning out scripts at the expense of proper counselling and care while rewarding those who do care and actually educate patients on the medications they are dispensing. I know there are challenges with this, but I think it's something to consider beyond just having a contract for a drug and being reimbursed solely based on the product. If it's actually profitable to provide care, or if unsafe work environments and frequent errors decrease what they get reimbursed I think the financial incentive may help turn things around, or at least encourage better practices.

---

Members don't see this ad.

 

[JMUDuke]

Something like this has already begun to be incorporated into the payment models. The pharmacy is given stars ratings on certain items like medication adherence for blood pressure, cholesterol, and diabetes meds. I know the software exists to monitor the individual pharmacy, but I think the overall idea is encompassed in medicare plans needing to reach certain stars.

The problem is I don't think there are controls in place to prevent the pharmacy from getting unnecessarily dinged. For example, patient on vacation makes one time stop, there is a potential for the pharmacy to get marked down for non-adherence. Same goes for a patient that needs a med that is deemed high risk for that patient population (elderly mostly). The pharmacy will get dinged every time they have to dispense that med to that patient.

http://www.mckesson.com/blog/star-ratings-measures/

 

[zelman]

There's also the fact that many providers are inaccessible, and our ability to independently correct/improve care is extremely limited.

 

[PharFromNormal]

In a way payment models are starting to evolve to incorporate performance measures. Just because you don't see the confidential payment contracts doesn't mean they aren't happening. Population performance on adherence is probably the biggest one. There's a lot that goes into this though. You also speak of "satisfaction rates". When you ask a large population of people what is a satisfying pharmacy you'll quickly learn all those speed metrics are actually what the general public desires. They want to be able to get to your store easy, you to have the medication in stock, it to be cheap, done when they want it done and have generally good customer service. We can huff and puff about our ability to bring more to the table but bringing our ability to prepare tofu to a BBQ competition isn't going to get a lot of traction. Value doesn't come from what we think we are worth, value comes from what others think we are worth. No one has been able to translate the self perceived value of the pharmacist into externally perceived value to the extent in which these alternative services are viable AND scalable.

 

[SClENCE]

The problem with this model is that patients usually only care about two things: speed and price. Neither of these reflect quality of care. The are only concerned with consolation when they want to avoid a doctor appointment or can't figure out which isle the homeopathic pain killer is in. Patients do, however, want the pharmacy to solve their insurance issues when they have 5 expired cards.