The Future of Pharmacy is Value-Based

This guest blog is one in a series by sponsors of the 2021 PQA Annual Meeting on emerging trends in medication use quality. The views shared in this series are those of the author and do not reflect any PQA positions.

Now is the most important time in history to be a pharmacist. When the pandemic hit, we were ready. Retail corporations quickly mobilized to provide same-day prescription delivery. Payers ramped up benefits to enable early refills and keep patients stocked and safe. And in the last 3 months, more than 60,000 pharmacies on Main Streets and city blocks across America transformed into vaccination destinations.

But gaps in our delivery system were also illuminated. Patients need efficient, timely access to primary care and that is still a challenge, especially in rural and underserved areas. This will remain an issue as we fight the next outbreak, crisis, epidemic, and so on. We need pharmacists in this fight.

Pharmacists are providers. Let that sink in for a minute. Pharmacists have been getting paid for services for over a decade. For instance, any licensed pharmacist can provide services to Medicare members and get paid via Medication Therapy Management (MTM) -- a program mandated by law and administered by CMS! Nearly half of our 50 states have passed legislation requiring health plans to reimburse pharmacists for services rendered.

However, the majority of MTM services are still performed from call centers. Why? Why don’t we see more frontline pharmacists providing services beyond dispensing and counseling?

Healthcare payment models have evolved since Medicare Part D was enacted 18 years ago. No one wants to pay for encounters. Everyone wants to pay for outcomes. Most payers have accepted value-based care as a reality and the real pioneers are pouring millions of dollars into innovative models and reaping the rewards.

Value-based arrangements that include pharmacists are a huge opportunity. There should be more focus on maximizing pharmacist ROI versus traditional strategies limited to minimizing pharmacy spend.

The barrier here is a technology gap. We need solutions that enable pharmacists to use their knowledge and skills to provide care efficiently and effectively. We need solutions that connect payers & pharmacists, administer innovative programs, and exchange payment for value. We built those solutions into DocStation because we believe the future of pharmacy is value-based.

Think of it this way. If you’re a health plan in Washington, Tennessee, Texas, New Mexico, West Virginia, Kentucky or one of the many states that have implemented payment parity for Medicaid, you’re about to see a sharp increase in fee-for-service payouts. Many of those claims will come from pharmacists using DocStation. Wouldn’t it make sense to tie those payments to outcomes?

Innovation will roar across the healthcare industry in the ‘20s. We have an opportunity to harness that power and do something extraordinary for patients. Collaboration and partnership between healthcare organizations and technology companies is crucial for success. Let’s build the future together.

Samm Anderegg, PharmD, MS, is the CEO of DocStation.

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