Payment Reform
Johanna Taylor Katroscik, PharmD
On May 16 and 17, 2022, APhA hosted the Optimizing Patient Outcomes: Health Plans and Pharmacists Summit. This groundbreaking summit brought together 31 innovative thought leaders from health plans and pharmacy practices to network and strategize best practices and pathways to better deploy pharmacists in evolving care delivery models that reduce overall costs and improve quality of care. The summit focused specifically on identifying scalable and sustainable models for covering pharmacists’ patient care services through payors’ medical benefits.
Setting the stage
Prior to attending the in-person summit, all attendees completed a survey to gather information on the value proposition for pharmacists’ patient care services, primary barriers to coverage for pharmacists’ patient care services, and participants’ goals for the summit.
Additional information was collected on the patient care services covered by the plan or within the pharmacy practice, payer type, benefit type (medical or pharmacy), and payment model type (fee-for-service, value-based, or hybrid).
Results of the presurvey showed that approximately one-third of participants identified as practicing pharmacists, and approximately one-third identified as representing representing networks of pharmacists, employer groups, hybrid roles in health plans and pharmacy practices, or professional associations. The top 3 areas that participants wanted to discuss at the summit were
- Learning how health plans are providing coverage for pharmacists’ patient care services in general and across the country
- Confirmation and strategies to convey that coverage for pharmacists’ patient care services drive value
- Strategies for implementing programs that provide coverage for pharmacists’ patient care services
Sharing successes and lessons learned
The summit began with a keynote address that explored trending developments in the health care system and highlighted how the future of the pharmacist’s role might look.
This thought-provoking presentation laid the groundwork for productive discussions and looked at some of the many ways that health plans and pharmacists working together can be mutually beneficial to all parties involved.
On the second day, the discussions continued with several presentations, panel discussions, and breakout sessions. A graphic illustrator was present to document, in visual form, key messages from discussions throughout the day (see her representation in this article).
The day began with welcoming comments from Theresa Tolle, BPharm, FAPhA, APhA president. “As the pharmacy landscape continues to evolve, it’s imperative to engage in the types of discussions that we will have today, centered around collaboration, creativity, and innovation. That’s why this summit is groundbreaking,” said Tolle.
This was followed by an overview of the national landscape of coverage for pharmacists’ patient care services and presentation of the presummit survey results.
Throughout the day, participants were able to learn from one another as well as have open discussions and debates about what is currently working, what still needs to be improved, and opportunities for working with each other in the future.
Four panel presentations, each with health plan and pharmacy practice representatives engaged, highlighted different coverage models for pharmacists’ patient care services that are currently being implemented throughout the country.
Presenters discussed the innovative ways they have been able to imple-ment coverage programs, including successes and barriers, and provided data on patient outcomes and insights into future directions.
Breakout sessions
In addition to the panel presentations, 3 breakout sessions afforded participants the opportunity to discuss what was heard in the panel presentations and share information from their work.
The breakout sessions were meant to be a safe place where attendees could freely discuss what they had heard as well as what they had seen work or not work in their own experiences.
The first breakout session focused on gathering additional information from all participants on their experiences with coverage for pharmacists’ patient care services. Participants were asked to discuss successes, challenges, and outcomes as well as what they thought might be beneficial for others to know about how to implement programs covering pharmacists’ patient care services.
In the second breakout session, participants focused on common themes regarding the value proposition for pharmacists’ patient care services and strategies for overcoming barriers to program implementation. Another important aspect of this breakout session was to gather recommendations for more effective messaging of the value proposition.
The final breakout session crystallized all of the information and shared knowledge throughout the summit into recommended one-year and five-year plans for scalable and sustainable coverage programs. Participants were also asked to consider and share some of the key takeaways they had from the summit.
The summit concluded with a discussion of how to move forward and how health plans and pharmacists could and must continue to work together to better serve patients. Summit participants also completed a post-meeting survey that is undergoing analysis. A comprehensive summary of what was learned from the summit will be released.
There is still much work to be done, but this summit was an important first step to creative thinking and collaboration between health plans and pharmacists. ■