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Volume 162, Issue 9
Pharmacists add value, but you need to show that to health-system executives.
The move toward value-based reimbursement can be a plus for health-system pharmacists.
Pharmacists can help health systems develop and meet benchmarks and performance targets in accountable care organizations (ACOs), bundled payment models, and other value-based systems.
To help the C-suite recognize their value, pharmacists must show them that pharmacy is a cost saver, says Michael Korczynski, PharmD, BCAP, manager of clinical services, Pharmacy-Ambulatory Care, for Allegheny Health Network in Pittsburgh. “Dispensing medicine is about 1% of my career. I’m a provider of medication management services, educating patients, educating staff, ordering labs, ordering referrals, being a contributor to the development of policy and procedure.”
Korczynski is hardly an outlier. Pharmacists nationwide are following examples set by Kaiser Permanente, Geisinger Health System, the VA, and other integrated health systems that rely on pharmacists for comprehensive medication management services.
“These systems are so integrated that physicians and pharmacists work in a shared success model where the number one goal is to focus on the disease state,” says Fred Pane, RPh, senior director for pharmacy at Coordinated Health. “While you are taking cost out of the system by improving medication use and management, you are improving clinical outcomes. That’s what pharmacists can contribute to value-based reimbursement.”
There are two reasons more health systems don’t rely more heavily on pharmacy, says Eric Maroyka, PharmD, director of ASHP’s Center on Pharmacy Practice Advancement. One is some health system leaders don’t recognize the value pharmacists bring. The other is pharmacy managers and directors don’t reach out to executives.
“You have to be proactive,” Maroyka says. “The level and complexity of drug therapy today is such that you cannot manage either outcomes or costs without the assistance of a pharmacist. [ASHP] members are finding success by thinking like the C-suite, learning what is important to them, and weaving a story that resonates around quality, revenue, and spending.”
The key step in helping an organization meet value-based targets is getting leadership to buy in. But don’t wait until value-based contracts have been signed.
“You have to have a seat at the table when quality, financial, and clinical are discussing and following up on value-based plans,” says Ashley G. Woodhouse, PharmD, manager of the St. Joseph’s/Candler Centers for Medication Management in Savannah, GA. “You have to know exactly what kind of value-based plans are being considered, the benchmarks being used, and what is not being assessed even if we know it should be.”
ACOs that track costs using the Medicare Savings Program, for example, are focused on Part B costs. Leaders need and want pharmacy to help manage Part B medications. “What you, in pharmacy, focus on,” Woodhouse says, “depends on the value-based programs your system is involved with.”