1. Reference: http://smartretailingrx.com

2. Analyze performance
Reference:

3. Reference: http://smartretailingrx.com

4. Analyze performance
Reference:

5. Reference: http://smartretailingrx.com

6. Reference: http://smartretailingrx.com

7. Pharmacy pay for performance is the way of the future

8. Keys on Impacting the Measures
Pharmacy performance
High-risk medication
Diabetes treatment
Adherence
Use
RAS antagoinst
prevention of fill or refill
Personalizing the solution
consistent follow-up
Synchronization
Based on Smart Retailing Rx (Insights for Better Pharmacy Health)
James A. Owen, Medicare star ratings: Stakeholder proceedngs on community pharmacy and managed care partnerships in quality, J Am Pharm Assoc. 2014;54:
Richard Logan, PharmD, is owner of L & S Pharmacy in Charleston, Mo., practicing with his son Tripp Logan, PharmD. Richard Logan can be reached at , or at semorx.com.

9. Diabetes treatment
Patient with high blood pressure recommended first line therapy: ACEI or ARB
Identify GAPS → Discuss → Contact Physician
MTM into your daily practice
Review patient profile or DUR, ask open-ended questions
Leverage whole pharmacy team ( including technician)
Based on Smart Retailing Rx (Insights for Better Pharmacy Health)
Climbing the adherence mountain: one diabettes patient at a time, Natalie Bari, Americas pharmacist journal
Richard Logan, PharmD, is owner of L & S Pharmacy in Charleston, Mo., practicing with his son Tripp Logan, PharmD. Richard Logan can be reached at , or at semorx.com.

10. Identify non-adherent patients and Discuss
Adherence
Identify non-adherent patients and Discuss
High quality interactions
Electronic refill reminders
Calls, IVR, text,
High quality interactions with patient
Find a reason for non-adherence, based on cause, select right tool of action
Dose reminders or compliance packaging
Solutions
Synchronization
PDC: Statins, Oral Diabetic Medications, RAS antagonist

11. Change to Safer drug choice
High-risk medication
Change to Safer drug choice
Utilizing patient targeting method
Participate in MTM
Utilize Beer Guidelines as clinical a reference when making therapeutic interchange recommendations to providers
Familiarize staff with list and common classes and review medications for coaching opportunities
Based on Smart Retailing Rx (Insights for Better Pharmacy Health
Beer Guide lines

12. How do we improve? Patient identification
Utilize your pharmacy-management system to run report → analyze by age, measures you want to approve, past refill, plans
Flag patients who are identified outside of workflow
MTM programs – also gives you service fee
Communication
educate
monitor
advocate
improve adherence, outcomes,
and save health care dollars.

13. What is limit of the measures?
Consideration about patient status
The diabetes treatment performance :
what about patients who cannot take an RAS antagonist?
The medication adherence measure for cholesterol :
what about patients who are unable to tolerate statin medications
Insufficience of true reflection
Different patients’ interpretations of what it means to be highly adherent
ACE inhibitor, angiotensin-receptor blocker, or direct renin inhibitor because of contraindications, adverse effects, or other clinical considerations
it requires a patient with coexisting diabetes and hypertension to have at least one fill of a RAS antagonist.
But what about patients who cannot take an ACE inhibitor, angiotensin-receptor blocker, or direct renin inhibitor because of, or other clinical considerations? 
Difficulty of high performance
Determining who exactly is “responsible” for the patient can be difficult.
Medicare star ratings: stakeholder proceedings on community pharmacy and managed care partnerships in quality.J Am Pharm Assoc (2003) May-Jun;54(3):

14. Pharmacy pay for performance is the way of the future.
Independent pharmacies are the major players
- medication adherence
- cost savings to health care.
Pharmacy related measures contribute more than 40%
to a plan’s star rating.
New contracts
based on performance
preferred networking
Pharmacyrelated measures contribute more than 40 percent to a plan’s star rating.
New contracts based on performance
CMS and plans realize there needs to be a new payment model for high-performing pharmacies.
Patients you have cared for will be forced to move to high-performing pharmacies, ones that know their numbers and star ratings.
A few health plans have started to venture into P4P for pharmacies, such as HealthPartners, Humana and Inland Empire Health Plan (IEHP). IEHP is partnering with Pharmacy Quality Solutions to administer the program, which is “designed to help validate the role of community pharmacies in promoting healthcare quality and define a pharmacy payment model for outcome-based services.”8
Yet, we are currently excluded from benefiting from our efforts.
Needs for
a new payment model
Part D's rating system could lead to bonus payments for high performing pharmacies by Richard Logan, PharmD; and Tripp Logan, PharmD, 2013 Nov
Medicare star ratings: stakeholder proceedings on community pharmacy and managed care partnerships in quality.J Am Pharm Assoc (2003) May-Jun;54(3):

15. If you are a High Performance pharmacy or Not…
Low Performance
May given Incentive from CMS or Insurance
look forward to more patients, and pay for service for caring for those patients.
You will be excluded from future contracting networks
It will limit your patient access.
EQuiPP

16. What We have to do ? Proactively manage patients.
Educate, monitor, advocate for patient
Improve their adherence, their outcomes
Save health care dollars.
Develop influence of pharmacy.
Have a network of high performance pharmacies
Prepare other measures.
Annual influenza vaccine
Cardiovascular care—cholesterol screening
Osteoporosis management in women who had a fracture
that can leverage reimbursements based on performance.
Creating a payer-pharmacy collaboration
Assessing and sharing a patient’s clinical status.
Medicare star ratings: stakeholder proceedings on community pharmacy and managed care partnerships in quality.J Am Pharm Assoc (2003) May-Jun;54(3):

17. Reference
1. Based on Smart Retailing Rx (Insights for Better Pharmacy Health)
2. James A. Owen, Medicare star ratings: Stakeholder proceedngs on community pharmacy and managed care partnerships in quality, J Am Pharm Assoc. 2014;54:
3. Richard Logan, PharmD, is owner of L & S Pharmacy in Charleston, Mo., practicing with his son Tripp Logan, PharmD. Richard Logan can be reached at , or at semorx.com.
4. PHARMACY QUALITY MEASURES : IMPROVING PERFORMANCE PLAYBOOK by Rx HealthMart
5. iMedicare; Medicare Part D Star Ratings and Pharmacy Performance

18. - Q&A -

19. Thank You!