HealthDecember 16, 2019

Taking a positive view: Building value-based services

The recently held National Community Pharmacists Association (NCPA) Annual Meeting provided an upbeat picture of community pharmacies trying to meet continuing pricing pressures by focusing on value-based services. A key part of the Association’s efforts is working with pharmacy champions to expand the Community Pharmacy Enhanced Service Network, or CPESN USA. CPESN are pharmacies providing value-based care delivery through the clinically integrated network. There are nearly 2,200 pharmacies participating in CPESN USA with networks launched or expanding in 44 of 50 states.

Author: Marsha K. Millonig, MBA, BPharm

A new effort called “Flip the Pharmacy” launched in October with a focus on CPESN and practice transformation in 20 communities in the United States. I was contacted by one of the program’s communications directors in October who let me know that “the main goal of our communications workgroup is to spread the news as far and wide as we can among the pharmacy community, and to generate excitement and enthusiasm for an industry that seems to be hearing mostly bad news these days.”

Flip the Pharmacy is focusing on transformation science to take many of the projects from the past 20 years that show the value of pharmacist services and create “scale” with a goal of transforming 5,000 pharmacies in 5 years. As stated on the program’s website, “Chronic conditions dominate the demand for healthcare delivery. It's time we transform pharmacy workflow and business modeling towards a whole patient, longitudinal orientation to match the need. And do it at scale. It's good for patients. It's good for payers. It's good for pharmacy sustainability.”

Specifically, Flip the Pharmacy will deploy a 24-month transformation process that emphasizes local supports and data-driven milestones using SMART (specific-measurable-attainable-relevant-timely) methodologies across six separate transformation domains. Those domains include:

  1. Leveraging the appointment-based model (medication synchronization) 
  2. Improving patient follow-up and monitoring
  3. Developing new roles for non-pharmacist support staff 
  4. Optimizing the utilization of technology and electronic care
  5. Establishing working relationships with other care teams
  6. Developing the business model and expressing value

More details on these six domains can be found at

Partners include CPESN and the NCPA Innovation Center. Support is being provided by the Community Pharmacy Foundation, an organization whose primary purpose is to assist community pharmacy practitioners by providing resources for research and development to encourage new capabilities and continuous improvements in the delivery of patient care. The effort will encompass a “change package” that all the 20 teams will use in conjunction with local coaches. These coaches will develop close relationships with the pharmacies and engage in frequent on-site visits to share data coming from the pharmacy’s patient care activities to provide insights and feedback on workflow, care processes, and business modeling. This is similar to the very successful process used by the Patient-Centered Primary Care Collaborative (PCPCC) a number of years ago.

And the scalable effort cannot come too soon! NCPA CEO Douglas Hoey noted in comments to the pharmacy state executives at their meeting in conjunction with the NCPA events that a recently conducted survey by the Association found 58% of those responding said if reimbursement does not change in the next several months, they are concerned about staying open. Further, 10 million patients have lost their pharmacy of choice in the last 10 months due to the reimbursement environment.

That thought was echoed by CPESN director of strategy and luminary development, Joe Moose, PharmD, who said, “Pharmacies remain in a system with a broken payment model that reimburses for a pill, not the ongoing health of the patient. That model is driving many community-based pharmacies out of business.”

The types of value-based services that are part of Flip the Pharmacy and CPESN include patient care services ranging from medication synchronization to immunizations and medication therapy management. In the 2019 NCPA Digest (released at the meeting), these services were provided by 79%, 77%, and 76% of survey respondents, respectively.

The focus on changing the pharmacy payment model was a major theme at the meeting. As Hoey noted in a [press release] and at the state executive meeting, “As economic pressures on pharmacies continue ­— and as more medical-side payers find value in community-based pharmacies — it’s increasingly important to change the pharmacy payment model to compensate for value and recognize pharmacists for the services they do and can provide.”

Stay tuned in the coming months to see how these efforts progress.

Marsha K. Millonig, MBA, BPharm, is president and CEO of Catalyst Enterprises, LLC, and an Associate Fellow at the University of Minnesota College of Pharmacy’s Center for Leading Healthcare Change.

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