Dear Colleague,
Anyone who has been through a pharmacy school program in the last 30+ years has had it ingrained in our brains that the profession must provide patient care services (AND, we at NCPA would add, be paid appropriately for those services which include medication dispensing).
Three keys to the success pharmacists and their teams had in being the number one public health response provider during COVID were: 1) Adequate payment for the service, 2) The service could be incorporated into workflow, and 3) A critical mass of patients who needed the service. Pharmacy teams currently have patient care opportunities — some of which pay decently per encounter. But what is almost always missing is the critical mass. A pharmacy owner/operator isn't going to change their business model to chase just a few patient care opportunities — the economics are often not enough to justify disrupting the dispensing workflow.
CMS just launched a new program where the payment per patient is okay, but the number of patients you already work with who qualify is huge!
Officially, ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions. The program is about ensuring that tens of millions of Medicare patients have access to chronic care services. But it also recognizes that health care providers, including pharmacists, need to have access to compensation to provide those services.
How many Medicare patients do you serve each day? How many of them have hypertension or pre-hypertension? Diabetes or pre-diabetes? I'm betting it's a lot.
The way ACCESS works is straightforward. The health care provider takes a baseline measurement for each patient based on a specified condition (for example, blood pressure for hypertension). That indicator is measured monthly thereafter for 12 months. The provider gets paid each month. Importantly, as an incentive to the provider, additional outcomes-based dollars are paid if the patient reaches their therapeutic goal.
One complication: Since pharmacists aren't recognized (yet) in Medicare as providers, a provider is needed to bill for the services.
To assist pharmacies in participating in the program, NCPA and CPESN have worked together in partnership with GamePlan Medical to create ACCESS to Pharmacy Care. This initiative streamlines participation in the CMS program for community and LTC pharmacies, with GamePlan providing medical director oversight as required by CMS. Pharmacies can participate if they're members of NCPA or CPESN and will receive a bonus per-patient payment if they're part of both organizations. Learn more here.
Here's another important thing to know: Because GamePlan Medical is the provider, all participating pharmacies in the ACCESS to Pharmacy Care program will be measured collectively. This is a case where one bad apple can ruin the whole barrel. To help ensure strong group performance, a pharmacy has to have 30 percent of its patients on med sync to participate in the program. That's one way to help ensure that all the participants have the operational capabilities needed to succeed, and reduces the risk that a few underperforming pharmacies could negatively impact outcomes and the shared performance payments earned by the group.
If your pharmacy is not at 30 percent med sync yet, there are a few ways to qualify, one of which is enrolling in the NCPA/CPESN Med Sync Fellowship and meeting attendance and homework completion goals. Don't be intimidated by the word "fellowship." I know it may sound kind of academic, time-consuming, and daunting. It's not. It's pragmatic and created by pharmacy owners for pharmacy teams. Some busy pharmacy owners ask one of their staff pharmacists or technicians to enroll in the program.
This is a unique opportunity for independent pharmacies to prove our value in reinforcing the profession's importance as a pillar in the U.S. health care infrastructure overall and get paid for services your pharmacy is probably already trained to do!
ACCESS is open to other health care providers — it's not exclusive to pharmacists and their teams. But this could be the first of other opportunities to prove what you and I already know: Pharmacists are the number one weapon the U.S. has against chronic conditions. Let's convert 30+ years of talk into action.
Best,
B. Douglas Hoey, Pharmacist, MBA
NCPA CEO
