Sunrise session helps McKesson ideaShare attendees navigate pay-for-performance models
SAN DIEGO — Attendees at McKesson ideaShare 2015 met the sunrise Friday morning with a special breakfast session that aimed to help independent pharmacies navigate the changing reimbursement landscape and gain entry to more narrowly focused preferred pharmacy networks.
In the session “Value-based Reimbursement Models and Their Evolving Role in Network Access,” co-presenters Kevin Connor, AccessHealth VP/GM; Eyad Farah, AccessHealth VP business development and strategy; and Stacey Decembrele, Express Scripts director of innovation and strategy retail channel management, spoke about how pharmacies can adapt to the new model.
Connor talked about one of the main trends taking place in community pharmacy today: the shift to value based reimbursement and the development of pay for performance models. In these models, patient outcomes dictate how a pharmacy is compensated; whether it’s performance-based reimbursement or per-patient incentive payments, where health plans pay pharmacies for conducting specific interventions and providing clinical services that leads to better health outcomes. As these innovative payment models continue to grow, what we’re going to see in the market place is some combination of all of these. In addition, this trend coincides with another important change impacting community pharmacy today, and that is the continued growth of narrow networks. Connor stressed that clinical performance will continue to have a growing impact on gaining access to preferred networks as well as improving pharmacy economics via value based reimbursement models.
Acknowledging the ways that changing reimbursement models and an emphasis on quality can change the way pharmacies operate, Decembrele provided several examples of how Express Scripts is working to help pharmacies collaborate better with health plans.
One initiative Express Scripts has undertaken is plan-specific quality reporting that ensures plans have access to Star quality-measurement information about pharmacists that they need to make future decisions about which pharmacies are providing their patients with the best care.
According to Decembrele, Express Scripts also is partnering with plans on plan-specific pay-for-performance initiatives to reward top-performing pharmacies, as well as those that had demonstrated improvement in driving health outcomes.
“We are certain from the data and conversations that certain pharmacies are doing more to make an impact on patient care,” Decembrele said. “Certain pharmacies are going above and beyond their standard operating procedure to support SCAN patients and support SCAN Star ratings. They're using the actionable data daily, and they use it immediately when it becomes available from us.”
Decembrele added that the movement toward pay-for-performance initiatives is an opportunity for retail pharmacy. Farah also emphasized this while outlining the ways AccessHealth can help make the transition manageable for community pharmacists, including leveraging awareness campaigns like the Health Mart-hosted town hall meetings with independent pharmacists that are taking place throughout the country and making investments in tools and services to increase customer and patient engagement like PQS EQuIPP access and Medication Synchronization solutions like StarWellness from PrescribeWellness, and utilizing a team of AccessHealth Advisors who provide reoccurring guidance around performance scores.
“We saw this shift coming, and we wanted to set up our pharmacies for success,” Farah said.
In terms of easing the transition so that pharmacists are able to provide the services needed to boost their performance and their reimbursements as a result, Farah pointed to the value of implementing a Medication Synchronization program.
“You can’t change your business model tomorrow, but if you start putting the foundation in place where you have more efficiencies to be able to dispense more scripts, but also free up time to provide those additional services to patients, that’s a win-win. Pharmacists are being asked to do more for less, which is challenging for the current business model, but there are also opportunities to drive patient outcomes and improve reimbursement at the same time,” Farah said.
The mark of a winner
SAN DIEGO — Four regional Health Mart pharmacies were recognized for their excellence with nominations for McKesson’s Pharmacy of the Year award, here at McKesson ideaShare 2015. Drug Store News caught up with each of the finalists in a series of one-on-one interviews at this year’s event, and it became clear that three traits were common among them.
First, each of the innovative Health Mart pharmacies were early adopters of many of the programs offered through Health Mart and McKesson, such as the Physician Outreach Program. Designed to help Heath Mart stores gain a competitive edge in their market by building relationships with local prescribers the program not only helps increase their patient base but also builds the stature each Health Mart has in its community.
More recently, McKesson has been emphasizing the need for independent pharmacies to implement a medication synchronization program, with a short-term goal to get 100 patients enrolled. “When we started this we actually went and marketed to 50 primary care doctors in our area, explaining to them this is what we’re going to be doing, this is how we’re going to reach out to your patients and this is how it’s going to help you,” Chas McCormick, owner of First State Health Mart Pharmacy in Wilmington, Del., told DSN. “It’s rewarding when we see something work.”
A second trait the winners share is they recognize the need to keep trying new things and looking for ways to improve the care they provide. McKesson ideaShare represents value each year because of the number of new, fresh ideas independent pharmacy owners can take home and implement in their own businesses, they said. “You cannot be status quo; you have to invest in ideas and innovation,” Shushma Patel, owner of The Prescription Shop Health Mart Pharmacy in Montebello, Calif., said. “You have to be innovative to succeed in today’s environment.”
Lastly, each of this year’s finalists weren’t merely focused on delivering good customer service. They were fanatical about it. The men and women who walked through their doors weren’t just customers or patients; they were family. “It’s a family business,” Jacob Johnson, co-owner of the Marble City Health Mart in Sylacauga, Ala., noted. “Treating employees like family, treating customers like family, it’s important. You can have all the programs you want to try to get your employees to understand your vision and buy in, but in a small environment like ours you can show them every day,” he said.
Taking that quality time with both employees and patients has certainly paid dividends for Marble City Health Mart, which was named the 2015 Pharmacy of the Year grand prizewinner by McKesson.
The editors and publishers of DSN salute the owners and the team at Marble City Health Mart, and the three other finalists — The Prescription Shop Health Mart Pharmacy, First State Health Mart Pharmacy and Towncrest Health Mart Pharmacy in Iowa City, Iowa.
Health Mart leaders reflect on year of massive accomplishment at group’s annual meeting
SAN DIEGO – Health Mart is taking patient relationships to the next level.
That was the key message Steve Courtman, Health Mart president, had for the standing room-only crowd of Health Mart pharmacy owners at the Health Mart annual meeting during McKesson ideaShare 2015. Courtman, who was led to the stage by a 12-piece marching band, shared his excitement about Health Mart’s major growth and massive accomplishments, and set the bar even higher for next year.
“We continue to enhance our quality, and it’s all built on the foundation of these great patient relationships,” said Courtman. “Your focus on monitoring EQuIPP to improve your quality outcomes is working — Health Mart exceeded the CMS Five Star goal in 2-of-the-3 adherence metrics, and we’re getting close to the Five Star goal on the high-risk meds measure.”
According to Courtman, more than 25% of the Health Mart stores are in the top 20% of all pharmacies in at least one measure. That’s good — but it is clear that good isn’t good enough for Health Mart’s top executive. “The Five Star goals are good, but we need to strive to be top 20% as a whole Health Mart network. Quality is what separates us from the competition,” he explained.
Health Mart’s focus on medication therapy management is also paying off, Courtman said. “In 2014, Health Mart stores were hard at work executing Mirixa MTM cases,” he said. “At our peak, we reached 70% of patients. The personal relationship you have with your patients helps you to have effective conversations, and these result in best-in-class MTM performance.”
And other independents are taking notice of the results at Health Mart. In the past 18 months, Health Mart membership has grown 25% Courtman reported, with the group now numbering more than 4,000 stores and growing fast. “Payers are seeking out Health Mart to discuss how to improve quality,” he said. “Health Mart is the best of a chain and the best of an independent because we can come together to create real change in the marketplace.”
To help Health Mart owners better compete for senior pharmacy patients, Health Mart introduced a Medicare Part D marketing package. “Seniors with their average 33 prescription fills per year are quite important to us,” he said. Medicare Part D open enrollment begins in October, and the plan changes go into effect Jan. 1. “The chains will be very active in and around both these dates, and so must we.”
To prepare independents for open enrollment, Health Mart offered “guides, webinars, experts to help you learn what to do to get ready and deliver plan reviews so customers understand what their options are.”
Another key focus this year for Health Mart is the adoption of medication synchronization to drive outcomes, grow prescriptions and profits, and generally improve the overall pharmacist workflow. Med Sync programs are helping independent pharmacists transition toward a more patient-centric consultation model.
“Our businesses are at an inflection point,” noted Tony Willoughby, VP and Health Mart chief pharmacist. “In my view, Med Sync is driving us back to how pharmacy was meant to be practiced, and quite honestly, it’s where independent pharmacists are great.”
Willoughby brought Health Mart owners Ramesh Upadhyayula, Desert Outpatient Hospital Pharmacy, CA, and Randy McDonough, Towncrest Pharmacy, IA, to the stage to discuss the transition in their businesses toward a patient-centric model.
“Gaining access to networks, bringing new patients into the store and expanding services: all three are necessary to help independent owners make that transition to a patient-centric care model,” Courtman said. “Let’s be specific as to what you can start today,” he said. “Be a top 20% performer as defined by EQuIPP, develop a Med D marketing plan to bring patients into your store and get at least 100 patients into a Med Sync program. This is about action. Get engaged. Become more involved.”
Health Mart also introduced a new award this year at the group’s Annual Meeting. Created to celebrate the unique qualities that set independent pharmacies apart, the first annual Health Mart Independent Spirit Awards went to three stores: Central Avenue Health Mart Pharmacy in Valley City, N.D.; Eden Drug Health Mart Pharmacy in Eden, N.C.; and Ben Franklin Apothecary in Duncanville, Texas.
Winners were given $1,500 to donate to the charity of their choice.
The Health Mart Annual Meeting closed with a presentation from motivational speaker Mike Robbins, author of the best-selling self-help books, including “Nothing Changes Until You Do,” “Focus on the Good Stuff” and “Be Yourself, Everybody Else is Taken.” Robbins, a one-time, up-and-coming pitcher in the minor leagues whose professional baseball career was cut short by an elbow injury, urged Health Mart owners to focus on their mindset, to be authentic in their interactions and to harness the power of appreciation. “You, as an owner and a leader, can really shift your mindset and perspective, and create the kind of change you want to see happen for you and the people around you,” he said.