Columbus, OH – 2/11/21.
Evolution within the practice of pharmacy has historically been on a fairly flat curve. For established pharmacists who have been at the trade for decades, the central driver of their business has always been traditional fees accrued from medication dispensing. There are limits to how far this can go, relative to the number of hours in the day, and the number of patients needing your services on a consistent basis.
The economic reality of running a pharmacy has become more opaque with the increasing involvement of PBMs over time and practices like direct and indirect remuneration (DIR) fees. Fee-for-service works well enough to an extent but is limited to specific disease states and is highly transactional in nature. It is not grounded in preventive care or a longitudinal focus on patient outcomes. Pharmacists can bill for certain consultations and functions, but that infrastructure dissuades innovation because financial solvency is tied to volume.
We find ourselves in a sort of limbo in pharmacy, currently. Independent, community-based pharmacists are equipped to do much more than dispense and occasionally consult. What’s increasingly required, and demanded, is industry-wide adoption of higher-level services and a more digital-friendly scope of practice.
Through Health in Motion Network and its comprehensive health engagement application, pharmacists will have better access to reimbursement through negotiated CPT codes, acknowledging the important role this healthcare provider can play in managing patient outcomes. Services like health coaching are far underutilized at this point in pharmacy’s history, but that is steadily changing, driven in part by a much more aggressive uptake of telemedicine platforms.
Similarly, PMPM (per member, per month) reimbursement relationships can incentivize comprehensive, wellness-focused care because the focus is removed from the localized intervention and retargeted towards long-term benefit. Flat rates calculated from member-based cost assessments are a step in the right direction.
Pharmacy services administrative organizations (PSAOs), so points out an earlier commentary from McKesson, should be advocating strongly on behalf of their member pharmacies, helping to: enhance reimbursement opportunities, minimize the impact of DIR fees, support contract negotiation, and grow your network.
This is where pharmacy really is headed. Modern pharmacy has to be recognized as a central player in healthcare, and reimbursed as such. This is not to take away, whatsoever, from the involvement of patients’ physicians and other providers. A meaningful medical home will ultimately be largely digital, with real-time and HIPAA-compliant communication among the patient and their entire care team.
Ultimately, HIMN is endeavoring to support shared savings and true value-based models of care. Healthcare will only cease to be so transactional and so tied to volume when it is genuinely in service of the patient, and with the patient central in the conversation. The providers should and deserve to be compensated appropriately for their expertise and skills. But, as it stands and has for a long time, it’s hard to find who really wins in this system. Integrating a digital-first platform with community-based, in-person care, incorporating interoperability and connectivity alongside traditional services and values, creates the pharmacy of the future.
Health In Motion Network delivers a consumer-centric, digitally enhanced healthcare ecosystem, enabling centralized and personalized, pharmacist-driven care management, empowering consumer choice and optimizing clinical outcomes.