Community Pharmacists’ Perceptions of Participation in a Sustainable Value-based Care Model for Comprehensive Medication Management

Community Pharmacists’ Perceptions of Participation in a Sustainable Value-based Care Model for Comprehensive Medication Management
Alyssa Falleni, PharmD, Hennepin Healthcare

Background: Comprehensive medication management (CMM) is a service delivered to patients with the goal to identify, resolve, and prevent medication therapy problems to optimize medication use. CMM, through pharmacist intervention, is a well-documented strategy to reduce the burden of suboptimal medication use in the US, improve clinical outcomes, and reduce overall costs to the healthcare system. Despite evidence showcasing the benefits of CMM, the consistent adoption of this practice in the community has been sporadic. Common barriers to CMM implementation are the lack of compensation for clinical services, time restraints, workflow interruption, and lack of knowledge in billing/documentation. However, even when a barrier such as compensation is addressed, pharmacist engagement has been limited. For example, despite Minnesota Medicaid adopting a payment model for CMM services, only 3.5% of 37,000 eligible Medicaid beneficiaries completed a CMM visit in 2011. Of 110 pharmacy organizations who submitted data, less than 5% were submitted by community pharmacists. Even when strong evidence exists for pharmacy interventions, real-world implementation takes time and consideration due to competing demands and barriers. In 2015, HealthPartners expanded their value-based care model for CMM services to include Partners in Excellence (PIE), a performance-based component. The aim was to incentivize participating pharmacies with bonus payments to conduct CMM visits in order to achieve engagement and quality metrics. Each quarter, HealthPartners provides lists of patients at risk for medication-related problems, based on collected claims data and medical history, to participating pharmacies. Three performance benchmarks are set for quality: blood pressure goal <140/90 mmHg, tobacco-free status, and hemoglobin A1c <8%. The engagement metric is defined as CMM services offered to at least 40% of eligible patients in a given year. Bonus payments would be granted based on achievement of these metrics.

Purpose: Participation by community pharmacists has been limited in the PIE program since its conception, prompting this study to examine three early intervention implementation outcomes: acceptability, appropriateness, and feasibility. For context, acceptability is the different stakeholders’ perceptions that a new service model is agreeable, appropriateness is the perceived fit or compatibility of a service for a specific practice setting, and feasibility is the extent to which a new service can be successfully used or carried out.

Study Design: This particular study was carried out through semi-structured, one-on-one qualitative interviews with a group of 10 pharmacists and four CMM pharmacy managers from participating sites.

Results: For acceptability, participants were in agreement that the clinical metrics were aligned with the conditions commonly affecting their patients. However, they felt there were other conditions that should be addressed and the narrowed metrics may prevent that exploration. Barriers were smoking cessation patient engagement, billing through the HealthPartners’ online portal, and delivering longitudinal CMM to patients who change insurers. When discussing appropriateness, participants felt that the PIE program aligned with their belief that community pharmacists play a role in patient care. However, many participants expressed concerns about the cost of the necessary software and the amount of time needed for patient visits, documentation, and billing. For the feasibility of collecting pertinent clinical information to conduct CMM, participants varied in their opinions, with some stating it was provided through their pharmacy and others expressing challenges with reaching out to a patient’s clinic.

Conclusions: CMM is an important tool for community pharmacists to address medication therapy problems. Community pharmacists and managers have positive perceptions of the use of a value-based care model but many identified implementation barriers to adopting a sustainable model in practice. The many barriers that exist for community pharmacies include patient and provider buy-in, time availability, the process to collect clinical information, documentation/billing, and delivering longitudinal CMM to patients who change insurers.

Key Point: The insight from this study could assist in developing a process to implement CMM more consistently in the community setting. Additionally, this study highlighted the role payers have in overcoming certain barriers, like providing pharmacies with clinical information, educating patients on the service, and offering flexible payment models. Moving forward, it is important that community pharmacy leaders ensure pharmacists have dedicated time, documentation resources, and technician support to provide CMM.

 

Reference:

  1. Pestka DL, Stoa MK, Sorensen TD, Blanchard CM. Community pharmacists' perceptions of acceptability, appropriateness, and feasibility of a value-based care model for comprehensive medication management. J Manag Care Spec Pharm. 2021;27(7):865-872. doi:10.18553/jmcp.2021.27.7.865