Forging a novel provider and payer partnership in Wisconsin to compensate pharmacists for quality-driven pharmacy and medication therapy management services

doi:10.1331/JAPhA.2009.08158

Journal of the American Pharmacists Association

Volume 49, Issue 5, September–October 2009, Pages 642-651

https://doi.org/10.1331/JAPhA.2009.08158 Get rights and content

Abstract

Objective

To describe the Wisconsin Pharmacy Quality Collaborative (WPQC), a quality-based network of pharmacies and payers with the common goals of improving medication use and safety, reducing health care costs for payers and patients, and increasing professional recognition and compensation for pharmacist-provided services.

Setting

Wisconsin between 2006 and 2009.

Practice description

Community (independent, chain, and health-system) pharmacies and private and public health care payers/purchasers with support from the McKesson Corporation.

Practice innovation

This initiative aligns incentives for pharmacies and payers through implementation of 12 quality-based pharmacy requirements as conditions of pharmacy participation in a practice-advancement pilot. Payers compensate network pharmacies that meet the quality-based requirements for two levels of pharmacy professional services (level 1, intervention-based services; level 2, comprehensive medication review and assessment services).

Main outcome measures

The pilot project is designed to measure the following outcomes

medication-use quality improvements, frequency and types of services provided, drug therapy problems, patient safety, cost savings, identification of factors that facilitate pharmacist participation, and patient satisfaction.

Results

The Pharmacy Society of Wisconsin created the WPQC network, which consists of 53 pharmacies, 106 trained pharmacists, 45 student pharmacists, 6 pharmacy technicians, and 2 initial payers. A quality assurance process is followed approximately quarterly to audit the 12 network quality requirements. An evaluation of this collaboration is being conducted.

Conclusion

This program demonstrates that collaboration among payers and pharmacists is possible and can result in the development of an incentive-aligned program that stresses quality patient care, standardized services, and professional service compensation for pharmacists. This combination of a quality-based credentialing process with a professional services reimbursement schedule is unique and has the promise to enhance the ambulatory pharmacy practice model.

Section snippets

Objective

The current work describes steps taken to lay the foundation for the project, details of the WPQC program, methods for providing support to the pharmacy network, the evaluation process, challenges encountered, and anticipated future plans.

PSW

PSW, which is the sole professional pharmacy organization in Wisconsin, represents pharmacists, pharmacy technicians, and student pharmacists practicing in any setting. Pharmacist membership in PSW (n = 2,482) represents approximately 50% of the licensed pharmacists in Wisconsin. PSW technician membership includes 377 members of the estimated 12,000 technicians in the state. A PSW organizational priority is enhancing pharmacy practice throughout the state.

Following passage of MMA in 2003, PSW

Establishing WPQC

In late 2005, PSW convened a member task force representing community pharmacies, ambulatory clinics, and managed care organizations to discuss potential methods for addressing pharmacy quality, pharmacy professional service standardization, and MTM services. The task force developed a draft document that described the components of a potential new MTM service model for Wisconsin. The Lewin Group Report was influential in the development of this document in terms of standardization of MTM

Outcome measures

This pilot project is designed to measure the following outcomes: medication-use quality improvements, frequency and types of services provided, drug therapy problems, patient safety, cost savings, identification of factors that facilitate pharmacist participation, and patient satisfaction.

Improvements in medication use will be demonstrated, the frequency and types of services provided will be documented, and resolution of drug therapy problems will be demonstrated by measuring specific

WPQC workgroups

WPQC created three workgroups: billing/documentation, return on investment, and evaluation/reporting. These groups engaged in detailed discussions that were eventually vetted through the full WPQC for consensus approval.

Legal counsel provided advice regarding antitrust regulations throughout the process. Discussion of specific payment levels was not permitted due to antitrust considerations. Instead, the return-on-investment workgroup prepared a document that projected improved patient outcomes

Pharmacy requirements

Participating pharmacies are required to have Internet access to use the Web-based MTM application and a private or semiprivate patient care area for providing comprehensive medication review and assessment (CMR/A). Participating pharmacies must also be willing to serve as mentors and trainers for future enrollee pharmacies as the program expands. WPQC pharmacies must agree to implement 12 quality-based best-practice requirements as conditions of participation. These network requirements are

Results

As of May 2009, the WPQC pharmacy network consisted of 53 pharmacies, 106 pharmacists, and 2 payers, representing approximately 77,000 lives in Wisconsin. A total of 121 pharmacists, 6 pharmacy technicians, and 45 student pharmacists have been trained on WPQC. The 45 students completed the WPQC home study and were trained by PSW staff while completing rotations at WPQC pharmacies. Fifteen pharmacists who were initially trained are no longer participating in WPQC because of employment changes or

Discussion

The development of the WPQC consortium and the WPQC network of pharmacies and payers has been exciting but challenging. However, we believe that each challenge encountered has led to the development of processes that have resulted in the provision of higher levels of quality service and that our experience in overcoming these challenges will inform others embarking on new models of MTM services.

We have gained a deeper understanding of the complexity of the contracting and implementation process

Conclusion

WPQC has created a model for practice advancement. We anticipate that this pilot will be sustainable and allow the pharmacy and payer network to expand across the state of Wisconsin. We are demonstrating that collaboration among payers and pharmacists is possible and can result in the development of an incentive-aligned program that stresses quality patient care, standardized services and professional service compensation for pharmacists, and the recognition of innovative leadership on the part

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: Disclosure: The McKesson Corporation developed the software application used by participating Wisconsin Pharmacy Quality Collaborative pharmacies and payers. The Pharmacy Society of Wisconsin received financial support from the McKesson Corporation for ongoing development work for this project.

: Acknowledgments: To the pharmacists and payer organizations that committed their time to developing the Wisconsin Pharmacy Quality Collaborative.

: Funding: Portions of this work were supported by a grant from the Community Pharmacy Foundation.

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ExperienceForging a novel provider and payer partnership in Wisconsin to compensate pharmacists for quality-driven pharmacy and medication therapy management services

Abstract

Objective

Setting

Practice description

Practice innovation

Main outcome measures

Results

Conclusion

Section snippets

Objective

PSW

Establishing WPQC

Outcome measures

WPQC workgroups

Pharmacy requirements

Results

Discussion

Conclusion

J Am Pharm Assoc.

J Am Pharm Assoc.

J Am Pharm Assoc.

J Am Pharm Assoc.

J Am Pharm Assoc.

J Am Pharm Assoc.

J Am Pharm Assoc.

J Am Pharm Assoc.

J Am Pharm Assoc.

Rewarding provider performance: aligning incentives in Medicare

Institute of Medicine. To err is human: building a safer health system.

Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century.

Experience
Forging a novel provider and payer partnership in Wisconsin to compensate pharmacists for quality-driven pharmacy and medication therapy management services