SHAPING THE OF PHARMACY
EMERGING TREND DEFINING QUALITY MEASURES
FUTURE
BETTER PHARMACIES
SAVE LIVES By: Jake Galdo, PharmD, MBA, BCPS, BCGP, CEO | Seguridad, MNF | CPESN Health Equity
A
s a community pharmacist, pharmacists put pills from the big bottle to the little bottle. According to Jerry Seinfeld, that’s all pharmacists do. According
to pharmacy benefi t managers, pharmacies just provide a commodity and cost center. According to the public, all pharmacists and pharmacies are the same. Because according to the board of pharmacy, pharmacists make sure the right patient gets the right medication, at the right dose, at the right time, and via the right route (and for the right reason). Every time.
“Data shows that half of all prescriptions have an error. T is could be as minor as an inaccurate number of refi lls, to as severe as wrong drug or wrong dose… or even wrong patient.”
Unfortunately, that’s not accurate. What
Jerry Seinfeld did not ruminate upon was, “What happens when the wrong pill gets into the wrong bottle for the wrong person.” Data shows that half of all prescriptions have an error. T is could be as minor as an inaccurate number of refi lls, to as severe as wrong drug or wrong dose… or even wrong patient. All pharmacists, pharmacy technicians, and pharmacies are NOT the same – better pharmacies with quality committed pharmacy teams save lives. So how do pharmacists express to Jerry Seinfeld, PBMs, boards of pharmacy, and ultimately, patients, that my pharmacy and
our pharmacist led team provide safer care and more value? T rough pharmacy network design. A ’pharmacy network’ is a loose collection
of pharmacies working together: pharmacy service administrative organizations (PSAOs), clinically integrated networks (CPESN MO), shared ownership (chain, grocery stores, mass market merchandisers), geography (MO versus KS), or even wholesalers’ selection – and many more dimensions can be considered networks. T ese networks impact all aspects of community pharmacies – from patient co-pay and overall reimbursement to the pharmacy or acquisition cost of a medication with the wholesaler to patient access but the quality of the service is not all the same. Currently, pharmacy network design
(inclusion and exclusion) is obfuscated to many stakeholders. Ask the vertically integrated monopoly’s PBM what the preferred pharmacy network is – and I bet it’s the company owned pharmacy. Years ago, I was told by one PBM my pharmacy wasn’t in network to dispense a refi ll for a patient’s Hepatitis C therapy – it didn’t meet the quality standard. Despite being recognized and published as a subject matter expert on this topic – and having dispensed the initial prescription! Instead the PBM- owned specialty pharmacy dispensed the medication. T is is what pharmacy quality measures
and measurement system are solving. Data and measures should drive the networks on three levels: • ‘Macro’ Network Creation – T e Big
Picture: Network A gets reimbursed $25 for lisinopril with a $1.25 copay. Network B gets reimbursed $5 for lisinopril with a $5
copay. Our pharmacy’s inclusion in Network A should be based on quality not the lowest cost denominator. • ‘Micro’ Network Quality Improvement
– At the Practice Level – In the above example, not all pharmacists and pharmacies in Network A are the same. Quality measures can help identify lower performing pharmacies and support quality improvement. Imagine a board of pharmacy having a report of safety quality measures and helping pharmacies transform the practice of their pharmacists before an error occurs. • Patient Choice – T e Gold Standard of
Healthcare: All patients want safety, high quality healthcare. Patient facing quality report cards – just like restaurants, health- systems, or movies – can help empower patients to make informed choice. I used these measurement systems to help our family make choices for my mom’s care. She had Alzheimer’s and when the disease progressed, we needed skilled nursing help. Our hospice social work recommended facility X. T e publicly available measurement system informed me that facility X was under investigation for elder abuse. We didn’t go there. CPESN Health Equity is using a
community pharmacy measurement system, Choose My Pharmacy™, to express value and show how our pharmacists provide a higher quality of pharmacy network. It’s helping pharmacists for ‘macro’ network creation and new value-based contracts. It’ helping pharmacists with ‘micro’ network quality improvement. And it’s helping our patient’s know the value and quality of a CPESN Health Equity pharmacy compared to the other store down the street.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST |
MoRx.com 19
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