Make Time, Utilize Pharmacy Team Members to Improve Payer Performance

Although finding the time and getting buy-in from pharmacy team members can be major challenges for those looking to improve payer performance, utilizing the right staff and making small changes can help, according to a roundtable session at McKesson ideaShare 2022.

During the session, attendees at each table discussed challenges and opportunities amongst themselves, before sharing their takeaways at the end. The session defined payer performance as the use of metrics that can increase reimbursements or decrease fees, and is intended to improve patient outcomes and lower health care costs.

When asked what they would change about this definition, several attendees pointed out that it seems inaccurate to include “increasing reimbursement” as a goal of payer performance, because this never seems to happen. Attendees also pointed out that payer performance overall needs to be simpler because it can be hard to know when a pharmacy is making or losing money.

Attendees also identified key challenges, including getting patients to participate in programs such as medication therapy management (MTM) or comprehensive medication reviews (CMRs). In some pharmacies, attendees said they have been able to utilize pharmacy students from nearby schools who can almost exclusively work on MTMs and CMRs, allowing the pharmacists and technicians to focus on other responsibilities.

Others encouraged pharmacists to use phone services rather than trying to schedule in-person appointments or waiting for patients to come into the pharmacy. If in-person appointments are still necessary, experiment and find the time of day that seems to work best for patients to avoid no-show appointments as much as possible.

Tackling MTMs and CMRs could also be an opportunity for part-time pharmacists or team members who predominantly work from home. One attendee emphasized that the approach to such conversations is important. By immediately telling the patient that it should only take 5 minutes and that it is required by their insurance, it may be easier to get patients to participate.

Toward the end of the session, discussion turned toward some key takeaways and how to address the biggest barriers to payer performance. Attendees said the most crucial step is to look carefully at return on investment, and fully utilizing technicians is important for any successful changes.

For example, several attendees said medication synchronization is an amazing tool that can help the pharmacist, the patient, and overall workload. However, others pointed out that some pharmacy team members can be resistant, especially because the first few months of implementation can be a challenge. By identifying leaders in the pharmacy, however, and empowering them to galvanize the other team members, implementing medication synchronization can successfully improve patient adherence and payer performance.

After discussing obstacles and solutions amongst themselves, the larger group of attendees concluded by reviewing some key takeaways. Firstly, finding the time to improve payer performance can be a major hurdle, but designating even 30 minutes per week can make a difference. In addition, finding programs such as medication synchronization can be challenging at first, but can increase workflow efficiency and inventory turns year over year.

Secondly, focusing on the metrics is essential to seeing improvements in payer performance. Outcomes and performance will continue to be key, and knowing which metrics to focus on can lower direct and indirect remuneration fees—a major challenge that all of the attendees agreed on. Some performance goals to focus on can include achieving the top 20% in adherence categories, achieving 80% or greater CMR completion, and achieving 100% targeted intervention program completion.

Finally, diversifying pharmacy offerings is crucial to add revenue-generating services. Performing additional MTM services, launching or expanding immunization services, and bringing new patients to the pharmacy are essential not only for payer performance, but to the future of the pharmacy industry overall.

REFERENCE

Affect Your Reimbursement: Payer Performance. McKesson ideaShare 2022. July 8, 2022.