The move away from traditional quantity-driven models toward value-based care has helped put pharmacists at the forefront of efforts to improve the quality of care patients receive.
The move away from traditional quantity-driven models toward value-based care has helped put pharmacists at the forefront of efforts to improve the quality of care patients receive. The pharmacist’s role continues to evolve into one that is part of a team of health care providers collaborating to innovate, share information, and improve outcomes.
For years, the health care industry has been coaxing pharmacists out from behind the counter so they can offer more services. Although the pressure was on for them to get in the quality business, reimbursement for their efforts has lagged. Times are changing.
Health plans are beginning to offer pharmacists financial incentives to help them achieve better star ratings, according to Sam Stolpe, PharmD, of the Pharmacy Quality Alliance. In his article on page 8, Dr. Stolpe discusses the changing landscape as well as ways that pharmacies can ensure they stay ahead of the movement. “To be successful, pharmacists will need to make a cultural shift to focus more on quality,” he says.
But sweeping changes of this nature can bring reimbursement anxieties to community pharmacies, notes Tripp Logan, PharmD, in his article on page 22. Dr. Logan discusses ways to allay those fears and “build the revenue bridges needed to shift from the current fee-forservice model to a scenario in which pharmacies are reimbursed for quality.” The Department of Health and Human Services’ aim to tie 85% of fee-for-service Medicare payments to quality or value by the end of 2016 and 90% of these payments by the end of 2018 illustrates just how rapidly stakeholders, including pharmacies, will need to converge on quality in order to be successful.
Although there are many ways to go about improving quality at the pharmacy level, including appointment- based modeling (see the article on page 12), wellness initiatives, and patient education, we know from past experience that financial incentives will ultimately drive the innovation and the change in pharmacy culture.
In his Editor’s Note, Directions in Pharmacy Co-Editor in Chief Troy Trygstad, PharmD, makes a case to “Let Quality Be Our North Star.” He notes, “Pharmacists can expect to see changes both in the scope of services they provide and the ways they are incentivized and reimbursed by health plans over the next few years.” He further argues that focusing on high-quality care will have the added benefits of improving efficiencies and reducing overall health care costs.
Better quality care and lower costs? That would be the ultimate win.
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