The Ability to Pay for Performance, Outcomes for Patients Past DIR

Pharmacies need to kind of move beyond those models that are more punitive and look for true pharmacy-based measures and the ability to pay for performance and outcomes for patients.

Crystal Lennartz, VP, General Manager of Health Mart Atlas, spoke to Pharmacy Times about her session at McKesson ideaShare 2022, titled "Pharmacy Beyond the Pill: Clinical Payment Services and Reimbursement."

Crystal Lennartz: There has been an increase in the number of performance-based payment models in recent years. A lot of those are in the Medicare space and tied to direct and indirect renumeration or DIR [direct and indirect renumeration] fees. We need to kind of move beyond those models that are more punitive and look for true pharmacy-based measures and the ability to pay for performance and outcomes for patients. There's a couple of examples where we've seen this work in practice. One is in the state of Ohio. We have a partnership and a pilot with Molina Healthcare of Ohio, where pharmacists are billing under the medical benefit for caring for patients, including those with mental health concerns or chronic conditions like diabetes or high blood pressure. Ohio has made that permanent for Medicaid and so we're seeing expansion of that which is really exciting. Another example is pay-for-performance where our pharmacies were involved in ensuring patients with diabetes were getting their A1C [glycated hemoglobin] tested. This was a particular barrier during the COVID pandemic, so the payer chose to send test kits to the patient's homes. Pharmacists would make sure they take that test and then also had the right results. We were able to see an increase in the amount of patients who are tested when pharmacists recommended it, as well as about a 20% improvement in overall A1C results for our patients as well.