A Pharmacy Payment Model in the Medical Home

May 16, 2017

Article

Lacking a system by which pharmacist get paid for their expertise and work may be what prevents pharmacists from being integrated into medical homes.

Pharmacists and pharmacies have been joining with health-care teams known as patient-centered medical homes (PCMH) for some time, but lack of a payment model may be a barrier. The Community Pharmacy Enhanced Services Network (CPESN) may have a solution.

The premise of PCMH is a health-care provider practice that gives patients a home base through which they receive health services that focus on outcomes.

Trista Pfeiffenberger, PharmDIn the CPESN network model, community pharmacists and medical practices work closely, with greater communication and collaboration than in conventional community pharmacies, said Trista Pfeiffenberger, PharmD, MS, Director of Quality and Operations for CPESN USA and Director of Network Pharmacy Programs for Community Care of North Carolina (CCNC). “Fundamentally, the relationship and the way the pharmacy and physician practice communicate with one another are different under this integrated medical home and CPESN model,” she said.

For example, some pharmacies in CPESN have access to the electronic health records of their partner medical practices, Pfeiffenberger said. Or, the pharmacist might drop by the practice once a week to discuss patient issues and progress, their disease states, and their medication regimen.

“One of our goals is that the medical practices understand that these pharmacies have a desire to take care of their patients differently, using population health strategies and focusing more on the highest risk, chronically ill patients,” Pfeiffenberger said. It is a value-based payment model in which pharmacies will be reimbursed for the enhanced services they provide to patients in the medical home practice.

CPESN NC is testing a per-member per-month payment model based on the severity of the patient risk and a performance score, she said. “The adjustment for the risk score of the patient helps ensure the pharmacy is paid more for working with more complex patients, since that work is more time-intensive.”

CCNC and CPESN have been using a grant from the Center for Medicare and Medicaid Innovation to fund payments to pharmacies, Pfeiffenberger said.

“Pharmacists have been integrated into patient-centered, team-based care settings for quite some time,” said Daniel S. Aistrope, PharmD, BCACP, Director of Clinical Practice Advancement for the American College of Clinical Pharmacy in Lenexa, KS.

A payment model that supports clinical pharmacists in the delivery of care in PCMHs would likely enhance a provider’s ability to contract with clinical pharmacists, Aistrope said, ”and achieve the medication-related outcome metrics measured by a PCMH.”

CCNC is using an innovative model for integrating pharmacists into a medical home, Aistrope noted. Their model “extends beyond the walls of the pharmacy to include the community pharmacist as a member of the collaborative health-care team. Such efforts focus on improving quality, efficiency, and access to care,” he told Drug Topics.

The CPESN network concept is expanding across the country, Pfeiffenberger said. There are emerging or active networks in more than 40 states.

The construct for a partnership between pharmacies and medical providers is the same across the networks, Pfeiffenberger said, but the nuts and bolts of how each works may differ depending on patient population, among other factors. For example, one pharmacy works closely with pediatric patients with asthma to provide education and assist with action plans, she said. Another works with an adult primary care practice to set up protocols for hypertensive patients so that blood pressure measurements are taken whenever they come into the pharmacy.