By now it’s no secret that independent and local pharmacies influence performance metrics for insurance plans and pharmacy benefit managers (PBMs) and, conversely, that PBMs rate their partners (those same pharmacies), using metrics that could very well affect their reimbursement.
Understanding how your pharmacy is being rated – and then taking the steps necessary to tighten up those metrics, can be key to improved performance which can translate into:
• Improved access to preferred pharmacy networks
• Better patient care and outcomes
• Increased revenue opportunities and
• A more efficient and effective management of operations
You might be wondering how, exactly, your pharmacy can help tighten up those very metrics they’re being evaluated on, so we’ve brought you five ways you can do just that.
1. Identify, review, and understand payer performance requirements
The first step necessary to shoring up metrics is knowing what metrics you’re being evaluated on. Review the reimbursement contract you have with your PBM and identify those metrics.
Some examples of possible clinical and operational metrics include:
• Medication adherence rates
• Filling a prescription with a generic option when available
• 90-day prescription fill rates vs. 30-day supplies
2. Identify the patients that are skewing the curve
Every pharmacy has them: patients who are nonadherent, at risk for becoming nonadherent, whose medication is not an approved formulary medication, or even those don’t take advantage of 90-day fill options. Identify the outliers and then move on to step 3!
3. Reach out to the outliers and offer help
There are many possibilities that can work to make a patient an outlier, but that doesn’t mean they have to stay in those positions. Once you’ve identified the patient and the issue that’s affecting your pharmacy’s performance, reach out to them and work with them to minimize those risks:
• Identify challenges that prevent their adherence
• Find safeguards for challenges that may pose future adherence issues
• Develop solutions that can help your patients reduce risk
4. Self-monitor your performance using contracted payer requirements
As an independent pharmacy, you monitor your sales and make adjustments to increase them. You also monitor your inventory and make adjustments to minimize turnover. So why not monitor your performance against contracted requirements?
Technology can help. For example, the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) has a dashboard that pharmacies can access that displays performance assessments. Once a pharmacy can see how they’re measuring up, they can identify areas that may need some attention and work to improve those areas.
5. Watch improved measurements boost leverage for your pharmacy
When you apply steps 1 through 4, your pharmacy should begin to see an improvement in its clinical and operational performance measurements. Those improvements are then leveraged to increase opportunities for additional revenue.
• Improved medication adherence rates can increase your pharmacy’s revenue as more prescriptions are filled and could earn your pharmacy more referrals
• Some PBMS use medication adherence goals in pay-for-performance reimbursement contracts
• Your pharmacy could also see a decrease in DIR fee liability and lower operating costs
In order to successfully apply these steps and reap their benefits, a pharmacy must learn how to be more proactive and hands-on with their patients. There’s some real work involved here, but it’s work that pays off financially for the pharmacy, and in improved health outcomes for the pharmacy’s patients.
And that’s another win-win.
When it comes to performance measurements, there’s a lot to consider, and it takes a solid understanding and marketing strategy to implement changes that are successful for pharmacies and their customers. That’s where we come in. PPSC is dedicated to helping you understand the nuances of successful marketing to maintain the health of your patients and improve your pharmacy’s bottom line. Just ask us and we can help.