What you need to know and do about Pharmacy Quality Measures right now to help benefit your patients and your business.
By Tony Willoughby, PharmD
Health Mart Chief Pharmacist
With the growing impact that quality measures will have on pharmacies retaining access to lives, this spring Health Mart® hosted a series of Town Halls titled “Pharmacy Quality Measures: Know Your Numbers.”
More than 2,000 attendees — owners, staff pharmacists and technicians — joined one of 65 meetings across the U.S. to hear peers speak and lead a discussion around:
- The shift in the healthcare landscape that is driving the increased focus on health outcomes.
- The evolution in the criteria payers are using to determine which pharmacies to include in limited and preferred networks.
- What are CMS’s five-star quality measures, why they matter to community pharmacies and how you can impact your pharmacy’s ratings.
- Why community pharmacies need to know their quality performance numbers and how to find out what they are.
- What steps community pharmacies can take to improve their quality measures.
Takeaways for Pharmacy Owners
Following these Town Halls, we chatted with Health Mart Regional Franchise Directors who attended these Town Halls. They summarized customers’ four key takeaways:
1. Changes in pharmacy are significant and real. The increased emphasis on outcomes and measuring quality isn’t a short-term fad; these are major changes that will affect all parts of health care, particularly pharmacy. Medicare Advantage plans now receive bonuses based on their quality ratings, so they want to create networks of providers (including pharmacies) who help them achieve good quality ratings — as it affects their reputation and bottom line.
Some attendees mentioned feeling overwhelmed at the changes taking place in pharmacy and described the current environment as one of “shock and awe.” But they also reinforced that it’s necessary to fully understand what is changing and what they can do to keep their patients.
“It was great information that your team put out.”
– Health Mart Owner
2. Access to lives requires understanding payer needs and addressing them. In addition to viewing patients as customers, it’s also helpful to think of payers as customers, and to figure out how to provide what they need.
While historically, payers created networks solely based on a pharmacy’s willingness to accept a certain rate, the criteria for network participation is evolving. Now, not only do payers continue to build networks based on coverage and cost, they also care about quality. For community pharmacies, this means that, in the future, being part of performance-based networks requires accepting a lower reimbursement rate and achieving high ratings on clinical measures of quality.
3. Community pharmacies must know and improve their quality numbers. Since future access to lives depends on a pharmacy’s quality ratings, it is essential for each pharmacy owner to understand precisely what is being measured and to know the pharmacy’s numbers. Only when the rating methodology is understood and an owner knows a pharmacy’s quality numbers can an owner decide on priorities and actions for improvement.
“It was great information. Concise. And gave me a high-level overview of the Quality Measure process. I’m going to make my entire team to go through the training.”
– Health Mart Owner
Get the specifics on medication-related metrics payers are reviewing and the tools they are using to compare your pharmacy’s execution in our article, “How Health Plans and PBMs Are Evaluating Pharmacy Performance.”
4. Med Sync and MTM are “must dos.” A major realization for attendees was that quality ratings are directly related to improvements in medication adherence. And, medication therapy management (MTM) and medication synchronization can make a difference in improving adherence and a pharmacy’s revenues. For example, speakers discussed Thrifty White’s med sync program implementation, resulting in each store of the regional pharmacy chain gaining tens of thousands of dollars in additional revenue. These activities are no longer ancillary, but essential.
Read “It’s Time to Start Offering Medication Synchronization” to learn more about the appointment-based model and the outcomes that Thrifty White pharmacies achieved.
“We will begin to implement a number of these programs and initiatives into our pharmacies.”
– Independent Pharmacy Owner
“When can I start?”
This was a common question from attendees at the end of the Town Halls. Speakers reviewed six steps that pharmacies could start taking right now to impact quality outcomes.
“This is the best news I ever had for my pharmacy; now I have a clear path to make a difference and make my business more profitable.”
– Health Mart Owner
How to Get Access to Your Quality Measures
You can’t improve your performance (and maintain access to lives) unless you know your baseline. EQuIPP™ (Electronic Quality Improvement Platform for Plans and Pharmacies), developed by Pharmacy Quality Solutions (PQS), is a web-based performance-management tool that makes unbiased, benchmarked performance data available to both health plans and community pharmacy organizations via user-friendly dashboards to bring a level of standardization to the measurement of the quality of medication use.
To demonstrate its commitment to helping its independent pharmacy customers thrive, McKesson has arranged for Health Mart and McKesson AccessHealth members to enroll with PQS and obtain their EQuIPP data as part of their membership, as well as get additional training and support to enhance performance. For more details, or if you’re not a McKesson pharmacy and want to talk about joining, click here to contact us today.
While these Town Halls covered a lot of ground, the key takeaway is clear: pharmacies need to understand how payers are measuring quality, know their current performance numbers and not wait to implement programs than can improve medication adherence, such as MTM and med sync.
Share your key takeaways from the Know Your Numbers Town Hall or related to pharmacy quality measures.