Pharmacist-Provided Care Continues to Expand Five Years After PQA’s Action Guide
Through convening events, research, pilots and work to develop standard pharmacy quality measures, PQA has been a national leader in advancing pharmacist-provided care. A 2018 PQA-convened task force identified 15 strategies to expand value-based pharmacist-provided care, which form the centerpiece of the 2019 Strategies to Expand Value-Based Pharmacist-Provided Care Action Guide. The guide was designed to spark conversation and foster collaboration between community pharmacy organizations, pharmacists and health care payers.
Loren Kirk, PQA’s Senior Director of Strategic Partnerships, managed the task force and development of the action guide. In this Q&A blog, Kirk reflects on the guide’s impact and shares his perspective on the collaborations that continue to shape pharmacist-provided care.
It’s been five years since PQA published the Strategies to Expand Value-Based Pharmacist-Provided Care Action Guide. What has been its impact?
There's a notable and positive transition from fee-for-service to pay-for-performance, as evidenced by the progress we’ve made as an industry. This progress is marked by an increased alignment between pharmacists and payers. More progress can be made, but payers are now taking pharmacies into greater consideration and better understand the value that pharmacist-provided care can contribute to health outcomes.
We're not claiming that we've solved everything, but we are actively and steadily moving toward our goal. There has been a definite increase in awareness among stakeholders about the need to transition to value-based models and arrangements that leverage pharmacy services.
A few years ago, everyone had similar issues, but there was a lack of understanding that these issues were common. The action guide facilitated a crucial dialogue, allowing stakeholders to realize that they all faced the same challenges and needed to solve them together. That includes care gaps and the ability of pharmacist-provided care to help close gaps, but also the challenges that relate to complex business partnerships, data sharing and infrastructure. In summary, the impact has been an increased awareness of pharmacist-provided care as a solution to these mutually experienced issues.
PQA has fostered numerous collaborations among payers, pharmacies and supporting technology partners. Where has PQA made the largest contribution?
These fostered collaborations have significantly contributed to the research, development, piloting and use of outcomes-focused quality measures or concepts that align with pharmacy services in integrated clinical care.
PQA has engaged payers, community pharmacies and technology vendors to test and use these pharmacy measures and measure concepts in real-world environments. These projects focus on hemoglobin A1C and blood pressure improvement and control and specialty pharmacy turnaround time.
In 2024, our work continues to test novel measure concepts and standard pharmacy measures. We will also generate much-needed evidence on the effectiveness of payer-pharmacy arrangements. Specifically, we're focusing on immunization gap assessments and rate improvements.
Among the guide’s 15 recommended actions, where have we seen substantial progress?
I would say the most substantial progress has been the change in hybrid reimbursement models and risk-sharing partnerships.
Payers and pharmacies have gotten creative about how they share risk. We've seen a progressive change among many pharmacies transitioning to operating models focused on pharmacist-provided care. For example, they've moved some tasks to automation and other methods to free up pharmacists’ time to provide clinical services. This has helped build larger relationships with payers and other partners in the medication use process.
Where do challenges persist in the transition to pharmacist-provided care and payer-pharmacy collaboration?
We realized during our work that data standardization and exchange issues are a significant challenge. We discovered these challenges through surveys and made recommendations about them. Similarly, when testing our blood pressure and A1C measures, we ourselves encountered these issues. There are big differences in data standardization, which hinder pharmacists' ability to play a greater role in outcomes-based health care.
Although the channels for data sharing exist, shared investments and collaboration are needed to leverage them effectively. Integrating pharmacy data with other clinical care data and payer claims data demands improved infrastructure and sharing agreements.
Another key challenge to tackle is the misalignment of goals and incentives. Despite progress, there are still difficulties managing and aligning the desired outcomes, goals, metrics and incentives of pharmacists, payers, providers and patients. This disconnect leads to inefficiencies and barriers to fully realizing the benefits of pharmacist-payer collaborations. The incentives may never truly align perfectly. Still, if more of them are not, we'll continue to face these barriers and inefficiencies in freeing up pharmacists’ time to deliver care and realizing the benefits of these new models.
So, it's not just a call-out of a specific recommendation, but overall, we've made progress on that spectrum from fee-for-service to pay-for-performance. The conversation has broadened and opened up, with pharmacies forging stronger ties with payers to enhance support and deliver pharmacist-provided care. We've made substantial progress in these areas, and it's beautiful to see how things are evolving.
Beyond PQA, where are you seeing promising payer-pharmacy partnerships?
The recently announced collaboration between CPESN USA and Express Scripts to expand access to care at independent pharmacies is an exciting development. We’re eager to see how that partnership evolves and what insights it can bring to the entire industry.
As the guide notes, collaborations between community pharmacists, health care payers, technology vendors and other stakeholders are critical in an industry that continues to consolidate, vertically integrate and expand.
When we were developing the action guide, we saw many promising collaborations between payers and pharmacies. These partnerships were often developing organically without needing a facilitator like PQA. Beyond PQA, these types of partnerships are forming on their own, in addition to those that PQA is facilitating.
Thinking about the progress, we now have many more examples of payer and pharmacy collaborations and partnerships than before.
What do you hope to see in another five years in payer-pharmacy collaborations?
Ambitiously, in another five years, I hope to see enhanced integration and data sharing. This means improved infrastructure and standardized data sharing mechanisms that allow for seamless integration of pharmacy data with other clinical data. Having access to comprehensive patient information will enable pharmacists to play a more significant role in outcomes-focused health care, thereby enhancing care coordination and patient outcomes.
I look forward to established and sustainable value-based care models, which should financially reward pharmacists for their clinical services and outcomes achieved. They will support sustainable partnerships between payers and pharmacies, focusing on patient-centered care that reduces overall health care costs and improves the quality of care for chronic disease management.
As we look to the future, I am hopeful for continued collaborations that build on the industry’s current momentum towards value-based care. We've witnessed the emergence of numerous partnerships, and we want to ensure they are building sustainable foundations. As we build more of these partnerships, it will yield better results more easily.
These are ambitious goals. If I were to be more straightforward, it would be to continue building on the inertia and momentum we've created over the last few years. We've built a lot of momentum, and it's going in the right direction. We need to continue this steady progress. Slow and steady wins the race, right?