Leverage Comprehensive Medication Management to Generate Revenue
A single pharmacy manager can be opportunistic enough to integrate new technology and build relationships that can impact the revenue reimbursement pattern.
“Show me the money!” Well, we know that pharmacist reimbursement has always been linked to dispensing prescriptions and processing drug orders. However, things are changing, although not as quickly as we would like.
Pharmacy staff and managers discuss various models, such as pharmaceutical care and drug therapy management, as a means of reimbursement. Although similar, each model was based on its predecessors and all of them contributed to pharmacy revenues. Comprehensive Medication Management (CMM) also builds on previous models, but has a more solid foundation in the value proposition, or economic benefits of pharmacist involvement, than other models and therefore could advance the ‘needle a little further.
Investigators argue for the economic viability of MWC, in a study published in Research in social and administrative pharmacy. The authors argue that pharmacist-directed MMT has consistently demonstrated positive clinical outcomes, primarily through the identification and resolution of drug therapy (PTP) issues. Examples of CMM interventions include adding an indicated drug, optimizing the dose, and stopping an unsafe or unnecessary drug.
The authors looked at CMM’s value proposition from different angles. From a third party perspective, CMM has the opportunity for the pharmacy to increase direct income from capitalized savings contracts and obtain quality related bonus payments. The pharmacy can also help healthcare plans improve their scoring scores with the National Committee for Quality Assurance, the Healthcare Effectiveness Data and Information Set, CMS Star, and other resources. . From a primary care perspective, CMM has the opportunity to benefit prescribers’ practices through increased direct revenue from traditional fee-for-service payments or shared savings, and also help them earn bonus points from quality.
Overall, the authors present a new conceptual framework describing the economic value proposition for MWC. Even in a somewhat policy-oriented article, the authors help pharmacy managers and executives looking to pave the way for value creation and income diversification. Pharmacy officials will need to engage in documenting and tracking results, which could be aided by evolving technologies such as Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT).
Pharmacies should seek to join rather than oppose health plans in order to leverage resources and create revenue streams for both parties. A single pharmacy manager may not change health policy at the national level, but he may be opportunistic enough to incorporate new technologies and build relationships that can impact the pattern of income reimbursement.
Additional information on “Value creation and management and strategic planning in pharmaceutical operations” in Pharmacy Management: Essential Elements for All Practice Settings, 5th.
Shane P. Desselle, RPh, PhD, FAPhA, Professor of Social / Behavioral Pharmacy at Touro University of California in Vallejo.
Tripicchio K, Urick B, Easter J, Ozawa S. Making the economic value proposition for the pharmacist Comprehensive medication management (CMM) in primary care: a conceptual framework. Res Social Adm Pharm. 2020.16 (10): 1416-1421.