Reference: http://smartretailingrx.com

Analyze performance Reference: http://smartretailingrx.com

Reference: http://smartretailingrx.com

Analyze performance Reference: http://smartretailingrx.com

Reference: http://smartretailingrx.com

Reference: http://smartretailingrx.com

Pharmacy pay for performance is the way of the future

Keys on Impacting the Measures Pharmacy performance High-risk medication Diabetes treatment Adherence Use RAS antagoinst prevention of fill or refill Personalizing the solution consistent follow-up Synchronization Based on Smart Retailing Rx (Insights for Better Pharmacy Health) http://smartretailingrx.com/regulatory-public-affairs/star-ratings-explained/ James A. Owen, Medicare star ratings: Stakeholder proceedngs on community pharmacy and managed care partnerships in quality, J Am Pharm Assoc. 2014;54:228-240. Richard Logan, PharmD, is owner of L & S Pharmacy in Charleston, Mo., practicing with his son Tripp Logan, PharmD. Richard Logan can be reached at 573-683-3307, or at rlogan@ semorx.com.

Diabetes treatment Patient with high blood pressure recommended first line therapy: ACEI or ARB Identify GAPS → Discuss → Contact Physician MTM into your daily practice Review patient profile or DUR, ask open-ended questions Leverage whole pharmacy team ( including technician) Based on Smart Retailing Rx (Insights for Better Pharmacy Health) Climbing the adherence mountain: one diabettes patient at a time, Natalie Bari, Americas pharmacist journal Richard Logan, PharmD, is owner of L & S Pharmacy in Charleston, Mo., practicing with his son Tripp Logan, PharmD. Richard Logan can be reached at 573-683-3307, or at rlogan@ semorx.com.

Identify non-adherent patients and Discuss Adherence Identify non-adherent patients and Discuss High quality interactions Electronic refill reminders Calls, IVR, text, email High quality interactions with patient Find a reason for non-adherence, based on cause, select right tool of action Dose reminders or compliance packaging Solutions Synchronization PDC: Statins, Oral Diabetic Medications, RAS antagonist

Change to Safer drug choice High-risk medication Change to Safer drug choice Utilizing patient targeting method Participate in MTM Utilize Beer Guidelines as clinical a reference when making therapeutic interchange recommendations to providers Familiarize staff with list and common classes and review medications for coaching opportunities Based on Smart Retailing Rx (Insights for Better Pharmacy Health Beer Guide lines

How do we improve? Patient identification Utilize your pharmacy-management system to run report → analyze by age, measures you want to approve, past refill, plans Flag patients who are identified outside of workflow MTM programs – also gives you service fee Communication educate monitor advocate improve adherence, outcomes, and save health care dollars.

What is limit of the measures? Consideration about patient status The diabetes treatment performance : what about patients who cannot take an RAS antagonist? The medication adherence measure for cholesterol : what about patients who are unable to tolerate statin medications Insufficience of true reflection Different patients’ interpretations of what it means to be highly adherent ACE inhibitor, angiotensin-receptor blocker, or direct renin inhibitor because of contraindications, adverse effects, or other clinical considerations it requires a patient with coexisting diabetes and hypertension to have at least one fill of a RAS antagonist. But what about patients who cannot take an ACE inhibitor, angiotensin-receptor blocker, or direct renin inhibitor because of, or other clinical considerations?  Difficulty of high performance Determining who exactly is “responsible” for the patient can be difficult. Medicare star ratings: stakeholder proceedings on community pharmacy and managed care partnerships in quality.J Am Pharm Assoc (2003). 2014 May-Jun;54(3):228-40.

Pharmacy pay for performance is the way of the future. Independent pharmacies are the major players - medication adherence - cost savings to health care. Pharmacy related measures contribute more than 40% to a plan’s star rating. New contracts based on performance preferred networking Pharmacyrelated measures contribute more than 40 percent to a plan’s star rating. New contracts based on performance CMS and plans realize there needs to be a new payment model for high-performing pharmacies. Patients you have cared for will be forced to move to high-performing pharmacies, ones that know their numbers and star ratings. A few health plans have started to venture into P4P for pharmacies, such as HealthPartners, Humana and Inland Empire Health Plan (IEHP). IEHP is partnering with Pharmacy Quality Solutions to administer the program, which is “designed to help validate the role of community pharmacies in promoting healthcare quality and define a pharmacy payment model for outcome-based services.”8 Yet, we are currently excluded from benefiting from our efforts. Needs for a new payment model Part D's rating system could lead to bonus payments for high performing pharmacies by Richard Logan, PharmD; and Tripp Logan, PharmD, 2013 Nov Medicare star ratings: stakeholder proceedings on community pharmacy and managed care partnerships in quality.J Am Pharm Assoc (2003). 2014 May-Jun;54(3):228-40.

If you are a High Performance pharmacy or Not… Low Performance May given Incentive from CMS or Insurance look forward to more patients, and pay for service for caring for those patients. You will be excluded from future contracting networks It will limit your patient access. EQuiPP

What We have to do ? Proactively manage patients. Educate, monitor, advocate for patient Improve their adherence, their outcomes Save health care dollars. Develop influence of pharmacy. Have a network of high performance pharmacies Prepare other measures. Annual influenza vaccine Cardiovascular care—cholesterol screening Osteoporosis management in women who had a fracture that can leverage reimbursements based on performance. Creating a payer-pharmacy collaboration Assessing and sharing a patient’s clinical status. Medicare star ratings: stakeholder proceedings on community pharmacy and managed care partnerships in quality.J Am Pharm Assoc (2003). 2014 May-Jun;54(3):228-40.

Reference 1. Based on Smart Retailing Rx (Insights for Better Pharmacy Health) http://smartretailingrx.com/regulatory-public-affairs/star-ratings-explained/ 2. James A. Owen, Medicare star ratings: Stakeholder proceedngs on community pharmacy and managed care partnerships in quality, J Am Pharm Assoc. 2014;54:228-240. 3. Richard Logan, PharmD, is owner of L & S Pharmacy in Charleston, Mo., practicing with his son Tripp Logan, PharmD. Richard Logan can be reached at 573-683-3307, or at rlogan@ semorx.com. 4. PHARMACY QUALITY MEASURES : IMPROVING PERFORMANCE PLAYBOOK by Rx HealthMart 5. iMedicare; Medicare Part D Star Ratings and Pharmacy Performance http://imedicare.com/medicare-part-d-star-ratings-pharmacy-performance

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