Performance-based pharmacy payment models: key components and critical implementation considerations for successful uptake and integration

• DOI: 10.18553/jmcp.2021.27.11.1568
• Publication Date: 2021-10-29T12:45:31Z
• Authors: Chloe Richard; Benjamin Y Urick; Shweta Pathak; John Jackson; Melanie Livet
• Keywords: Reimbursement

BACKGROUND: In the United States, shift towards value-based health care seeks to improve patient outcomes while reducing spending. Although federal government has led implementation of performance-based models for physicians and systems, commercial entities have largely been responsible development similar within pharmacy. For purposes this study, pharmacy payment (PBPPMs) were defined as prescription drug that determine reimbursement or fees community pharmacies based in part on measured performance. These PBPPMs incentivize by linking performance measures. However, design lack transparency not described literature. OBJECTIVES: To (1) describe structure States (2) identify contextual motivational influences need be considered successful uptake integration these models. METHODS: A search peer-reviewed grey literature was undertaken. addition, semi-structured stakeholder interviews conducted with a convenience sample 17 individuals who pharmacists, payers, quality measure developers vendors, academics, advocacy organization leaders. Data analyzed understand current opportunities improvement, well considerations included facilitators, barriers, key insights. RESULTS: This study identified 4 major components US PBPPMs: attribution, measures, incentive structures, services. number barriers (eg, alignment) recommendations adequate incentives facilitate change) highlighted. Notable centered around establishing common ground among stakeholders avoid misalignment encourage engagement; importance quality-driven, innovative, flexible organizational culture access data infrastructure, adjusted workflows, relevant trainings; (3) supporting cultural transition care; (4) application financial at pharmacist level. CONCLUSIONS: better develop implement PBPPMs, it is first critical define needed changes their structure. identifying factors influence can future uptake. illustrates landscape makes improvement design. models, following are highlighted: increase alignment measures structure; embrace innovative business models; carefully plan use roadmaps outline implementation; foster all levels care. DISCLOSURES: sponsored Pharm-Alliance, an alliance between schools University North Carolina Chapel Hill, Monash University, College London. Urick reports consulting from Pharmacy Quality Solutions Cardinal Health, unrelated work. The other authors nothing disclose. podium presentation under title "What Makes Performance-Based Payment Models Work?" AMCP Nexus Virtual, October 2020.