New guide details actions for pharmacists and payers.
Recognizing the desire for pharmacists to solidify their role as an indispensable member of the clinical care team, the Pharmacy Quality Alliance (PQA) has developed a guide to increase the adoption of pharmacist-provided care.
The guide, released on March 26th, 2019, includes 15 actions that can be taken by healthcare payers and community pharmacists to increase cooperation between pharmacists and payers. To develop the guide, the PQA surveyed more than 50 representatives, including community pharmacy organizations, community pharmacists, healthcare payers, and technology vendors. It then held a roundtable with more than 25 industry experts to discuss the successes and opportunities of collaborations between community pharmacies and healthcare payers.
"Pharmacists are the clinicians most accessible to patients and uniquely positioned to provide care that effectively engages patients in medication management and chronic disease management,” says Laura Cranston, RPh, PQA chief executive officer. “The recommended actions identified by this task force can help pharmacists sustainably partner with payers and other healthcare stakeholders to deliver essential, value-based care.”
The results of the survey and roundtable indicate there is a need for standardization of services and supporting education, advocacy, and marketing.
Continue reading for the 5 recommended actions for community pharmaicsts...
Implement a pharmacy operation model focused on pharmacist-provided care.
The PQA found that the models that offer the best clinically relevant and financially sustainable care are those focused on patient engagement. Implementing these value-based care payments in pharmacies might result in the establishment of new partnerships with payers, employers, and other clinicians; improve the medication adherence and clinical outcomes in complex chronic diseases; increase patient participation in preventive health services; improve the performance on quality measures; and even decrease the total cost and patient utilization of care.
Medication synchronization is believed the be one of the more effective means of transition to pharmacist-provided care, according to the PQA’s roundtable. Conversely, volume-based prescription fulfillment and reimbursement models restrict a pharmacist’s position as a member of the clinical care team.
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Train frontline pharmacists to transition to a pharmacist-provided care model
Employers should be providing training that keep pharmacists’ clinical skills up to date, explain newer reimbursement processes and outline methods for overcoming technology and data access issues, PQA suggests.
According to the results of the survey, pharmacy organizations and payers will have to share in the risks associated with investing in training despite the initial lack of guaranteed reimbursement for pharmacists and patient confidence.
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Optimize efficiencies and efficacy of care delivery to allow pharmacists to be profitable while delivering valuable care.
Pharmacists need to identify a sustainable balance between time and resources required to provide quality patient care and partner with payers to improve outcomes and appropriately reward pharmacists. Some suggestions offered in the guide include leveraging clinical practice guidance, developing of standardized checklists, and using toolkits from credible organizations.
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Standardize patient engagement and care delivery to provide consistent clinical care and optimal outcomes across diverse patient populations.
Patients and payers will receive positive, predictable, and reliable care experiences with optimal outcomes from practices like medication synchronization, medication therapy management, and the optimization of services and interventions.
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Educate stakeholders about pharmacists as essential, effective, and accountable care providers.
Stakeholders that would benefit include those searching for high-quality/low-cost care, effective team-based and accountable care partnerships, employers or healthcare purchasers designing effective care benefits, and patient-centered services.
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In addition to these five actions, the guide also suggests that pharmacies and payers can work together to identify clinical areas in which to expand use of pharmacist-provided care, identify shared patient outcomes and goals, align strategies to integrate the value of pharmacist-provided care, implement pharmacist-provided care in all community pharmacies, and prioritize patients to receive pharmacist-provided care across payers.