Strategies for community-based medication management services in value-based health plans

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• 作者：Marie A. Smith ; Pharm.D. ; F.N.A.P.^a ; ^{marie.smith@uconn.edu} ; Susan Spiggle ; Ph.D.^b ; Brody McConnell ; Pharm.D. (c)^a
• 关键词：Medication management services ; MTM ; Pharmacists ; Payers ; Primary care ; Value-based health plans ; Alternative payment models
• 刊名：Research in Social and Administrative Pharmacy
• 出版年：2017
• 出版时间：January-February 2017
• 年：2017
• 卷：13
• 期：1
• 页码：48-62
• 全文大小：290 K
• 卷排序：13

文摘

Health plans are moving away from a volume-driven payment structure toward value-driven and risk-based contracts. There is very limited information on commercial payers' perspectives on coverage of medication management services (MMS) in value-based alternative payment models. While some health plans have experience with Medicare Part D Medication Therapy Management (MTM) programs, this experience does not promote the integration of pharmacists as health care team members.ObjectivesThe study objectives were to: (1) understand the evaluation process that health plan executives would use to determine benefit coverage for pharmacist-provided MMS in value-based health plans, (2) identify the facilitators and barriers that affect pharmacist-provided MTM services at the community pharmacy level, and (3) propose strategies for pharmacist-provided MMS in value-based health plans.MethodsThis study used qualitative research methods that involved structured key informant interviews with commercial health plan executives and focus groups with community pharmacists who had experience providing MTM services.ResultsHealth plan executives agreed conceptually that MMS could be a valuable program and recognized its potential. However, the most substantial barriers that health plan executives expressed were funding MMS in today's fee-for-service payment models; lack of physician infrastructure to implement and manage MMS; and difficulty in collecting timely, accurate data to execute and assess MMS programs. Community pharmacists identified the most serious barrier to altering health outcomes through MTM as the current lack of integration of MTM with a coordinated health care team. MTM services are conducted as a separate program by pharmacists who do not have access to patient health records, are time-constrained, and poorly incentivized.ConclusionsThe findings can inform the development of successful strategies for pharmacist-provided MMS that align with emerging value-based health plans and alternative provider payment models. Current MTM program barriers and facilitators are identified that could be addressed in future Part D MTM program policy changes.