Most contracts now have penalties for not reaching targets, and adherence remains a challenge.
Discussions of value-based contracts or care delivery across populations are one thing—but how do they translate into change for pharmacists?
Crystal Lennartz, PharmD, MBA, chief pharmacist for Health Mart, and Jim Kirby, manager of Clinical Strategy and Programs for Kroger took questions on this topic at the session, “Pharmacy Performance in Value-Based Networks,” part of the 12th annual meeting of the Pharmacy Quality Alliance in Baltimore, Maryland.
Lennartz said value-based arrangements have reached an “inflection point” where most contracts now have penalties for failing to make targets, including clinical quality measures. In pharmacy, adherence is the big focus, and the use of 90-day fills is commonplace.
She pointed to a project in Iowa that started with 600 patients who needed intensive medication therapy management (MTM). The savings reached the millions, and the lessons from that program have been shared with 200 retail pharmacies of all types: independents, grocery, and chain.
Medication synchronization—the practice of ensuring that patients can pick up all their medications at the same time each month—is an important first step, Lennartz said, followed by coaching techniques that allow pharmacists to “meet the patient where they are.”
Kirby said it’s taken awhile to get pharmacists at the store level engaged in clinical management; initially, there were complaints that no one had enough time. “This is the number one question,” he said. “You find the time. It’s the patients behind the prescription who need the help. That’s the cultural change that’s hard.”
The question dealt with the everyday practical problems: does it make sense to convert to a 90-day fill when patients are already not adherent? The answer was “yes.” How do you define how much time you need for patients when some have 15 medications and may require an hour of your time? Lennartz said while many measures are at the population level, more work is being done with pharmacy-level metrics in recognition of these issues.
Work with primary care providers is key, and Lennartz talked about the importance of building relationships. Systems are fine—and necessary—but there’s nothing wrong with sharing business cards and text messages. It’s more important to move the needle with patients than to just fill prescriptions, she said.
Kirby said the growth of value-based relationships has taken time, but it’s finally bringing awareness of the need for clinical services within pharmacies. “Using MTM has elevated what we do,” he said. While this is a good thing, it’s also raised accountability.
Of course, there are some problems that don’t change just because value-based relationships are in place. “If anyone has a magic bullet on adherence, I want to hear it,” Kirby said.