How CMS Affects Pharmacists, Health Plans

March 18, 2015

A common thread across all US Centers for Medicare and Medicaid Services programs is a shift of risk off of CMS and onto health care providers.

A common thread across all US Centers for Medicare and Medicaid Services programs is a shift of risk off of CMS and onto health care providers, according to Sam Stolpe, PharmD, senior director of Quality Strategies and Business Development at Pharmacy Quality Alliance.

In this video, Dr. Stolpe addresses how incentive models will impact health plans, namely with quality bonus payments and the benefits of 5-star ratings.

“Community pharmacists have a phenomenal ability to impact those measures embedded in Part C and [Part] D,” Dr. Stolpe says of the CMS programs.

He also notes that the relationship between health plans and pharmacies is changing. What used to be a connection surrounding costs associated with contracting is transitioning to a relationship based on quality components.

These quality measures will be moving front and center when health plans consider what pharmacies they choose to serve their beneficiaries, Dr. Stolpe notes.