And Medicare, Medicaid, and private insurers are increasingly willing to pay.
Adding patient care services to monthly medication synchronization appointments can improve patient outcomes and cut total patient-care costs. As a result, Medicare, Medicaid, and private insurers are increasingly willing to pay pharmacies for them, David Pope, PharmD, CDE, told McKesson’s ideaShare 2016 in Chicago.
Patient care services require ongoing patient engagement and monitoring, Pope noted. Community pharmacies are well suited to deliver, especially in smaller cities and rural areas where hospital and physician services are sparse. “You are the line of defense that no one else can reach. The health system needs you.”
Pharmacy adds value
Community Care of North Carolina (CCNC) demonstrates how effective community pharmacies can be in improving outcomes and lowering costs. Hospital admission rates are 40%-50% lower among Medicaid patients who receive care coordination from CCNC pharmacists than those who don’t, and readmission rates are 20% lower for patients receiving transitional care. Over four years, this has saved Medicaid nearly $1 billion (www.ccnccares.com).
CMS has asked CCNC leaders to help set up similar programs, known as Community Pharmacy Enhanced Services Networks, in other states. It’s part of CMS’ commitment to value-based payment, which includes tying 90% of Medicare payments to quality and value by 2018. Private insurers also are beginning to pay pharmacists for managing chronic-care patients, Pope said.
The first step to leveraging med sync is moving from delivering medications on a designated day to delivering them at a specific appointment time, Pope said. This enables preparation and time to engage patients.
Pope stressed dosing care services to individual needs. For example, a 64-year-old individual with uncontrolled hypertension, diabetes, and hypercholesterolemia needs more attention than a 28-year-old patient with controlled hypertension and no other chronic conditions. “Insurers won’t pay if it’s not appropriate to the patient,” he said.
Documentation is also critical. “If you didn’t document it, you didn’t do it,” Pope said. He also advised checking patient’s insurance for coverage, and ensuring your pharmacy meets any requirements for delivering specific services.
Diabetes self-management is already paid by many insurers, Pope said. Medicare allows 10 hours the first year and two hours in following years. He suggested a one-hour initial appointment, two two-hour group follow-up sessions, and one 25-minute session at each monthly med sync appointment. Payment totals $350-$450 depending on location and payer.
With just 28% of adults over age 60 vaccinated for herpes zoster, and 20% of those over age 19 for Tdap, adult immunization is a big opportunity, Pope said. Your technicians can check state registries to identify patients who need vaccines, and offer them at appointments.
Medication therapy management is more efficient if combined with med sync, Pope said. Many Medicare Advantage and private plans cover it. Utilize technicians to research medications and past patient issues, so you can focus on your interventions.
Expanding your med sync helps free time and organize your pharmacy to deliver patient care, Pope said.
Decide what services you want to deliver. This depends on patient needs, which are quite different in Utah than Mississippi, Pope noted.
Start patient care with 10 patients who are already enrolled in your med sync program and have multiple medications and disease states. You may be able to bill for disease management services.
Make the interventions and measure the results. The more impact you show on patient outcomes, the stronger your case for insurance payment, Pope said.
How you approach patients about your services will greatly affect participation. When Pope called patients and asked if they wanted to join his program, only about 40% did. When he introduced it when patients came in with prescriptions, and framed it as a service the patient could refuse, more than 95% joined. “Just do it,” he said.