Tip of the Week: Leveraging Comprehensive Medication Management to Build Revenue

Shane P. Desselle, PhD, RPh, FAPhA

A single pharmacy manager can be opportunistic enough to incorporate new technologies and build relationships that can serve to impact revenue reimbursement schema.

“Show me the money!” Well, we know that pharmacist reimbursement has historically been tied to prescription dispensing and medication order processing. However, things are changing, even if not as rapidly as we would like.

Pharmacy personnel and leaders discuss various models, such as pharmaceutical care and medication therapy management, as avenues to reimbursement. While similar, each model has built upon its predecessors, and all have contributed to pharmacy revenue. Comprehensive medication management (CMM) also builds upon previous models, but has a stronger foundation in the value proposition, or the economic benefits from pharmacist participation, than other models and thus might move the needle a bit further.

Investigators make a case for the economic viability of CMM, in a study published in Research in Social and Administrative Pharmacy. The authors argue that pharmacist-led CMM has consistently demonstrated positive clinical outcomes, mostly through the identification and resolution of medication therapy problems (MTPs). Examples of CMM interventions include addition of an indicated medication, dose optimization, and discontinuing an unsafe or unnecessary medication.

The authors examined CMM’s value proposition from various perspectives. From a third-party perspective, CMM has an opportunity for pharmacy to increase direct revenue from capitated savings contracts and to achieve quality-related bonus payments. Pharmacy can also help health plans improve their ratings scores with the National Committee for Quality Assurance, the Healthcare Effectiveness Data and Information Set, CMS Star, and other resources. From a primary care perspective, CMM has the opportunity to benefit prescriber practices through increased direct revenue from traditional fee-for-service payments or shared savings, and also to help them earn quality bonus points.

In all, the authors present a novel conceptual framework describing the economic value proposition for CMM. Even in a piece geared somewhat toward policy, the authors aid pharmacy managers and leaders seeking to pave the way for value creation and diversification of revenues. Pharmacy managers will have to be committed to documentation and tracking of outcomes, which might be assisted with evolving technologies such as Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT).

Pharmacies should seek to partner with, rather than oppose, health plans to leverage resources and create revenue streams for both parties. A single pharmacy manager may not change health policy at the national level, but they can be opportunistic enough to incorporate new technologies and build relationships that can serve to impact revenue reimbursement schema.

Additional information about “Creating and Managing Value and Strategic Planning in Pharmacy Operations”in Pharmacy Management: Essentials for All Practice Settings, 5e.

Shane P. Desselle, RPh, PhD, FAPhA, Professor Social/Behavioral Pharmacy at Touro University California in Vallejo.

REFERENCE

Tripicchio K, Urick B, Easter J, Ozawa S. Making the economic value proposition for pharmacist comprehensive medication management (CMM) in primary care: A conceptual framework. Res Social Adm Pharm. 2020.16(10):1416-1421.