As a new model of health care delivery takes shape, the way a patient or consumer looks at “value” in the pharmacy space is undergoing a transformation.

Traditionally, value to a patient was based heavily on convenience, as measured by location, cost and speed. But, as more of the health care spending burden shifts to the patient, “value” is taking on new meaning. Today, and going forward, value is becoming all about the quality of care.

“What we are starting to see is a shift that began, in my view, because we as consumers own more of the health care dollars,” says Health Mart chief pharmacist Tony Willoughby. “We have higher deductibles and higher co-insurance.”

An early indication that “quality” was becoming a key influence in pharmacy choice came in a study published in 2013. The study, published in JAMA, showed new beneficiaries in Medicare Advantage plans were making enrollment decisions based on Medicare’s Five-Star Quality Rating program. (The study found that the likelihood to enroll increased by 9.5 percentage-points for every rating increase of 1-star.)

“We see this influence flowing down over the next three to five years to our Health Mart situation,” Willoughby says. “Part of this is due to pharmacy saturation…If three pharmacies are all close to me, how do I as a patient or consumer get more benefit for that health care dollar spend?”

The answer, of course, is by considering the quality of care that’s provided.

With this shift to quality as a key driver of pharmacy choice, Health Mart leadership has set out to develop structures that ensure its stores are prepared with training and programs focused on improving the quality of care.

To match the growing emphasis on clinical services, Health Mart has invested in a new role – Chief Pharmacist. In this role, Willoughby is responsible for the clinical vision and designing a road map to ensure Health Marts get recognition by payers and PBMs for delivering improved patient outcomes.

“The core foundation of our strategy is to help our stores perform their best clinically,” Willoughby says. “We are trying to empower them to be innovative in areas of care so they can deliver higher Star Ratings and higher HEDIS (Healthcare Effectiveness Data and Information Set) ratings. Those are the ratings that payers are going to look at as they define quality for their members.”

In addition to holding more than 200 Town Hall Meetings over the past year to talk to members about the significance of the quality ratings, Health Mart has partnered with Pharmacy Quality Solutions (PQS) in a program that offers stores access to pharmacy performance data via PQS’ EQuIPP platform. This helps the Health Mart pharmacies to better understand their performance on medication-related Part D Star Ratings measures. “We firmly believe performance measures are a source of advantage and independents should be focusing on performance to improve patient outcomes. For this reason, we partnered with the Pharmacy Quality Alliance (PQA) to supply every Health Mart member with their EQuIPP pharmacy performance data,” states Willoughby.

Health Mart also has expanded its “Health Mart University” continuing education curriculum with additional courses to help members interpret and improve their quality-measure performance. The courses, which are pharmacist-led, are designed to help provide pharmacy owners and their staff instruction on activities that drive adherence, reduce medication risks and close medication gaps.

These programs, like other strategies developed by Health Mart leadership, have come about with critical input from the network’s pharmacist owners, according to Willoughby. He notes that he and other members of the management team spend a great deal of time talking with the Health Mart owners to get a better understanding of their situations. These owners are also very innovative, Willoughby says, and are the genesis of many good ideas that are woven into strategic planning.

“We build our strategy based on their needs,” he says. “What pharmacists talk about to us are the issues of access, delivering quality care and how to differentiate clinical services ... They are the innovators and we just empower them with the tools that move those innovations across the marketplace.”

Another area in which Health Mart is providing extensive support to its pharmacy members is in the area of specialty drugs, with its Health Mart Specialty Solutions offering.

Health Mart has partnered with Diplomat Pharmacy, a leader in the specialty drug category, to help members better compete in what has become the fastest-growing segment of the pharmaceutical market based on dollar sales. Through the partnership, Health Mart is able to streamline specialty access, provide reimbursement services and build relationships with specialty prescribers.

“It’s really important to pharmacies within our network that they can keep a patient ‘whole’ and take care of all of that patient’s needs within their pharmacy,” Willoughby says. “So we were looking for ways to help members keep the specialty patient in the store.” (The patient being treated with specialty drugs typically utilizes other traditional medications that Health Mart pharmacies are well positioned to provide.)

Willoughby notes that, with the rapid growth, the specialty category also brings along some hurdles that independent pharmacies have to overcome, from distribution to the support mechanisms that are needed for dispensing specialty drugs.

Other challenges include the higher wholesale cost of most of these drugs, which raises inventory management issues, and the accounts receivable dollars tied into the dispensing. There also are prior authorization and other back-office requirements that have to be met. Through its partnership with Health Mart, Diplomat provides support with the prior authorization and payer requirements, along with the clinical monitoring that often is required by the drug manufacturer.

The Health Mart pharmacist still does the counseling and provides the patient education, Willoughby says. “And we are also helping the prescriber community by providing a local solution for their patients. And that’s important to them.” Health Mart has created marketing materials for health care professionals “to let the providers know that we can take care of the patients within the community,” he adds.

The Specialty Solutions offering is a recent pilot introduction, but Willoughby says he expects to see more uptick with Health Mart members going forward.

This is another example of how Health Mart continues to evolve the tools and solutions it provides as new health plan and provider opportunities arise in the marketplace.

“We spend a lot of time listening to our members and we spend a lot of time researching trends in the industry,” Willoughby says. “We want to do our best to provide our members with the tools and services that are the most relevant to them.”

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