Resolving Payments in Ambulatory Care

In this video, Thomas Pierson, PharmD, MS, Manager, Specialty Clinics, Cleveland Clinic, Cleveland, OH, discusses reimbursement payment issues for pharmacists in the ambulatory care setting. This video was filmed at the 2019 American Society of Health-System Pharmacists (ASHP) Summer Meeting in Boston.

Thomas Pierson, PharmD, MS: The reimbursement conundrum really stems from the fact that we’re transitioning from a legacy fee for service model where health care institutions and prescribers are incentivized to use more treatments and more expensive treatments due to better reimbursement for those therapies and for those treatments. Rather than focusing on the actual clinical value that does help to achieve for patients.

What we’re seeing now is a transition into more value based or risk based contracting with health care organization that help to reward providers for achieving better clinical outcomes for their patients, regardless of the cost for therapy.

I think the largest role for pharmacists would be partnering with prescribers to identify what are the best, highest value therapies that patients can be prescribed to treat their conditions. And making sure that patients are on the right drugs and off the wrong drugs. This helps us to decrease the overall cost of care and improve clinical outcomes for patients in the ambulatory setting.