“Optimizing Pharmacy Performance Opportunities” webinar offers comprehensive review of the strategies required for the successful navigation of 2016 preferred networks
SAN FRANCISCO, February 17, 2016 – Investing in the continued success of independent pharmacies, McKesson AccessHealth® has expanded its comprehensive suite of reimbursement and performance enhancement tools and relationships. As pharmacy reimbursement models continue to evolve with greater focus for pharmacies on clinical performance and patient outcomes, McKesson AccessHealth has worked with other industry leaders to develop a comprehensive series of tools, resources and webinars to help independent pharmacies understand all aspects of the reimbursement landscape in order to improve patient health outcomes and optimize reimbursement.
It is estimated that in 2016, more than one-third of Medicare D claims through AccessHealth contracts will include performance-based reimbursement incentives. This means that as an incentive for top performance, those pharmacies or pharmacy networks who display top performance will be charged a smaller DIR, or Direct and Indirect Remuneration, amount than those who underperform. This evolution presents independent pharmacies with an enormous opportunity to reduce their DIR charges, thereby maximizing their potential reimbursement. While DIRs are not new to the market, DIR performance opportunities are. In previous years, pharmacies were charged a specific DIR amount with no opportunity to improve upon the amount. This represents a significant shift in the DIR landscape with a transition toward DIR performance opportunities in 2016.
“While the shift to preferred networks and new reimbursement models is challenging for many independents, there are also opportunities for incentives, and we are preparing our members to take advantage of them. There is a tremendous chance for innovative pharmacies to leverage their strengths, improve their overall pharmacy performance and maximize their reimbursement by interacting with their patients and providing care,” said Eyad Farah, vice president of business development and strategy, McKesson AccessHealth. “To help our members take advantage of the opportunities available to become top performers, we have made significant investments in tools and relationships designed to help them increase patient engagement.”
AccessHealth Pharmacy Performance Guidebook: Building on the comprehensive Medicare Part D Reimbursement and Performance Guide introduced in November, the Pharmacy Performance Guidebook helps members understand the overall performance focus of each PBM or plan. Overall performance scores are impacted by the ability to positively influence patients’ health outcomes, and the Guidebook offers detailed instructions on how to develop action plans to improve patient behavior and boost outcomes using such tools as medication therapy management (MTM) case completion, refill reminder programs, medication synchronization and behavioral coaching.
AccessHealth DIR Estimator Tool: DIR is a term used by the Centers for Medicare and Medicaid Services (CMS) for price concessions related to the Medicare benefit, and DIR fees are typically used to lower patient cost or improve patients’ health outcomes. DIR fees are collected at varying times throughout the calendar year, so it is important for a pharmacy to consider anticipating and planning for this collection in advance. The new AccessHealth DIR Estimator Tool allows a pharmacy to enter information specific to them and estimate accrual and incentive amounts that may impact DIR payments in order to plan accordingly.
AccessHealth Webinar Series: AccessHealth hosted a series of webinars designed to help independent pharmacies prepare for new reimbursement rates as well as identify opportunities to leverage the movement toward pay-for-performance incentives. The most recent webinar, “Optimizing Pharmacy Performance” (December 10, 2015), featured an in-depth overview of the 2016 operational and clinical performance requirements of preferred networks and specific strategies for successfully maneuvering preferred networks. Recordings of all of the AccessHealth webinars, including “What to Expect for 2016 Medicare Part D” and “AccessHealth 2016 Medicare Part D Reimbursement and Performance Guide” are available on the Managed Care tab of McKesson Connect or mypharmacy.McKesson.com.
In addition to these new tools, AccessHealth has invested in a number of partnerships to help develop comprehensive performance solutions to help member pharmacies navigate this changing landscape and prioritize their performance efforts in 2016:
- EQuIPP™: AccessHealth members receive this tool as part of the existing suite of services. Offered by Pharmacy Quality Solutions (PQS), EQuIPP is a performance information management platform that makes unbiased, benchmarked performance data available to both health plans and community pharmacy organizations.
- PrescribeWellness: With this relationship, AccessHealth members who subscribe to the McKesson Reimbursement Advantage℠ Plus (MRA+) offering have access to PrescribeWellness’ medication synchronization software tool, StarWellness. The software is designed to make it easier for members to build customer loyalty and provide extended services such as appointment-based medication delivery. According to Tony Thuyen, chief strategy officer at PrescribeWellness, “We are committed to ensuring the pharmacies are equipped with solutions addressing Star Ratings, medication synchronization and revenue. As one of the largest PSAOs, AccessHealth has invested in the Enterprise Patient Engagement Center, enabling transparency to network performance with the goal of negotiating better contracts and, ultimately, helping stores manage performance.”
- Mirixa: AccessHealth has made significant investments to build awareness and encourage top performance through pharmacy coaching and technology solutions for its members, including working with Mirixa, the leading provider of medication therapy management and targeted patient-care services. AccessHealth was the top performing PSAO in Mirixa case completion for 2014, and their EQuIPP scores met or beat all other PSAOs in a large, national pay-for-performance program.
- McKesson Reimbursement Advantage (MRA) and McKesson Reimbursement Advantage Plus (MRA+): In response to the changing market and the industry’s increased concentration on CMS Star Ratings, AccessHealth has integrated pharmacy clinical performance data into the McKesson Reimbursement Advantage program. These value-add offerings are tremendous solutions to help pharmacies tap into their performance opportunities and provide a dedicated coach to assist pharmacies on their performance journey. In fact, AccessHealth pharmacies that enroll in MRA or MRA+ have higher Star Ratings performance scores than AccessHealth pharmacies that do not enroll in one of these solutions.
About AccessHealth
AccessHealth is the managed care solution for more than 5,500 small and medium chain pharmacies, nationwide. AccessHealth provides its members with access to important narrow networks through strategic contracting, increases pharmacy efficiencies through its consolidated reimbursement processes, and provides the tools needed to help its members become top clinical performers in today’s shifting industry. As a market leader in managed care solutions and support for independent pharmacies, AccessHealth provides the expertise and tools needed to help its member pharmacies gain access to patients and narrow networks and compete in the evolving market.
About McKesson
McKesson Corporation, currently ranked 11th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit McKesson.com.