A Value-Based Program between Health Plan and Pharmacy Practitioners

May 8, 2020

What is the program?

University of North Carolina Eshelman School of Pharmacy, University of Minnesota Twin Cities, and HealthPartners have formed a partnership to facilitate a learning and action collaborative around the delivery of medication therapy management (MTM) services for HealthPartners Partners in Excellence Program (PIE). PIE is a health plan pay for performance and recognition program for physicians, medical groups, and pharmacies that achieve top-notch marks in health, experience and affordability. The learning collaborative, or “Slice of PIE,” supports community pharmacists in integrating MTM services into their practice and make the most of PIE’s pay-for-performance opportunities.

Since 2006, HealthPartners has provided payment for MTM services in its Medicare and Medicaid products. In 2010, HealthPartners expanded payment to include all commercial lines of business. The health plan evolved and expanded the program after internal analyses demonstrated a significant return on investment when high-risk patients receive MTM services.

While the PIE program has strong participation by pharmacists practicing within medical clinics and health systems, community pharmacist participation has lagged. HealthPartners is committed to supporting community pharmacists in their efforts to deliver MTM services as a strategy to support the health of their plan members. Community pharmacists often experience competing priorities and unique barriers that limit participation in MTM programs. However, community pharmacists are viewed as an integral part of building a strong network of MTM providers that can reach HealthPartners members wherever they live and have the trust of the patients they serve.

How is PIE different?

The HealthPartners PIE program is distinct from typical value-based compensation approaches in its adoption of both clinical performance and engagement performance metrics. Pharmacists are paid a fee for MTM services based on the time they spend with a member. In addition to this encounter payment, pharmacy providers are eligible for performance-based payments. Performance benchmarks are associated with members achieving blood pressure control, diabetes control (A1c) and a tobacco-free lifestyle. Pharmacy entities meeting performance benchmarks for clinical metrics are then eligible for a second tier performance payment based on plan member engagement in MTM services.

How are pharmacists supported in PIE?

The design of the program reflects an important strategy for health plan and provider partnerships. HealthPartners realizes a net return on investment when targeted populations receive high quality MTM services. To support pharmacists in their efforts to deliver these services, the health plan conducts beneficiary attribution to providers, provides information to support pharmacists in engaging these members, and offers a payment structure that recognizes an MTM provider’s contribution. On the provider side of the partnership, pharmacists commit to providing MTM services established by the payer, conduct outreach to health plan members to engage them in services, and submit clinical data to the plan.

Who can join the PIE program?

The PIE program has sought to be as inclusive of pharmacy providers as possible. Pharmacists are eligible as providers regardless of practice setting and there is no proprietary technology required for documentation or claims submission. But even with financial incentives in play, the shift in day-to-day practice activities to deliver MTM services can be a leap for some community-based pharmacists.

Future blog posts will describe the evidence-based engagement and implementation strategies we have paired with the HealthPartners PIE Program to further support practice transformation in participating pharmacies.

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