More Payers Will Recognize Your Value in Improving Patient Care

"Value-based pharmacy" will bring BIG changes to your practice...and more attention to your role in improving the quality of patient care.

This new thinking has health insurance payers recognizing the value and impact that pharmacists have in the med-use process.

It will pave the way for pharmacies to be paid more based on quality of care and outcomes...and less on dispensing alone.

Green Shield Canada is the first payer to start this pay-for-performance initiative in Canada...but expect others to follow.

Pharmacies that submit claims to Green Shield are assigned a "Patient-Impact Score." The score is derived from drug claims submitted to Green Shield by the pharmacy.

For example, the payer will look at refill history to evaluate adherence to non-insulin diabetes meds, statins, ACEIs, and ARBs. They'll also watch for high-risk meds in the elderly...and poor asthma control by looking at refills of rescue inhalers (salbutamol, etc).

Pharmacies with better Patient-Impact Scores will get higher reimbursement from the payer. Expect reimbursements based on your pharmacy's score starting sometime in 2020.

Patients will also be able to see your pharmacy's score...and may choose to use a pharmacy with higher ratings.

Continue to find ways to improve quality of care. For example, generate reports to identify patients with late refills...watch for return-to-stocks of chronic meds...and try motivational interviewing to improve adherence.

Consider implementing med synchronization or blister packaging to align refills of chronic meds...and to provide an opportunity for you to assess if meds are optimized for your patient.

Empower your techs to help with identifying patients, checking patient profiles, completing documentation, etc. This expands their skill set...and gives you more time with patients.

For more tips to help you improve patient care and impact scores, see our toolbox, Value-Based Pharmacy.

Key References

  • www.cfpnet.ca/en/news/details/id/242
  • www.opatoday.com/Media/Default/Eblast/GSC_Value-
    based_Pharmacy_Initiative_Communication_Aug18-2017.pdf
  • www.greenshield.ca/en-ca/news/post/measuring-the-performance-of-pharmacies
Pharmacist's Letter Canada. Jan 2019, No. 350124



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