CONCLUSIONS & IMPLICATIONS FOR FUTURE RESEARCH

Conclusions

This dissertation explores the impact of CMS’ Medicare Star Ratings program on retail pharmacies. Currently, health plans are implementing different value-based incentive (VBI) programs to try to incentivize pharmacies to achieve higher performance ratings on quality measures, particularly those related to star ratings. Despite the present changes occurring in pharmacy associated with VBI programs, little research has been conducted to understand the relative impact on retail pharmacies. This dissertation sought to provide a greater understanding of this impact through three specific goals: 1) identifying potential VBI programs being

implemented and defining a conceptual framework of the strategies being employed with each VBI program; 2) understanding retail pharmacists’ attitudes and perceptions of quality measure and impact of potential VBI programs; and 3) evaluate the potential financial impact of select VBI programs on retail pharmacies.

The first paper (Chapter 2) provides a categorization of potential VBI strategies being employed through various VBI programs. The paper defines three distinct strategies: quality-based payment (QBP), value-quality-based contracting (VBC), and quality-quality-based network (QBN). Each strategy presents a distinct way health plans are attempting to improve quality performance ratings from retail pharmacies. Furthermore, the paper identifies 5 distinct VBI programs being

considered or already implemented which reflect the strategies defined in the categorization of VBI strategies and characteristics of how they may be implemented in practice. A survey was used to support the collection on information on potential programs being considered or implemented. The paper compares identified strategies and programs to established theory in human behavior research (operant conditioning). Overall, the paper helps provide a more cohesive understanding of how certain dynamics of the health plan-retail pharmacy relationship are evolving to place an emphasis on quality performance ratings through VBI programs.

The second paper (Chapter 3) explores retail pharmacy’s perception of these changing dynamics. Pharmacy managers from both independent and chain retail pharmacies who were actively engaged in understanding and adapting to quality performance ratings were interviewed.

While several concerns were voiced regarding the resources required and change necessary to achieve high ratings, the respondents generally favored the impact of quality measures on the profession of pharmacy and the quality of care provided to patients. While research has previously been conducted understanding the perceptions of the lay retail pharmacist on star ratings, this paper provides a more nuanced perspective of those being proactive in addressing how quality performance ratings may affect retail pharmacy practice. In doing so, this paper adds to the literature by adding a more robust discussion of pharmacist attitudes and opinions of the changes occurring due to the environment’s shifting focus toward incentivizing high-quality performance ratings.

The third paper (Chapter 4) evaluates the financial impact to retail pharmacies of possible VBI programs. Three examples of VBI programs were developed and their outcomes estimated in Mississippi Medicare claims data. The research provides the first look at how pharmacies may be rewarded or penalized based upon their performance. Particularly, the financial impact from a

pharmacy losing their largest Medicare contract demonstrates the need for retail pharmacies to pay close attention to the VBI programs being implemented within the health plans of their patients. While programs implemented in practice may differ than those evaluated in the

research, the outcomes still provide a foundation for pharmacists and health plans to discuss the impact of VBI programs and cooperatively design programs which benefit both parties.

Implications for Future Research

The research associated with this dissertation was conducted with the goal of providing a greater understanding to how retail pharmacy is being impacted by healthcare’s shift toward achieving high quality performance ratings. While the research represents a meaningful step forward in understanding the impact of VBI programs on the retail pharmacy, there remains much to understand. While five distinct VBI programs were identified, additional programs are likely to be developed. The three strategies proposed through this research should serve as a foundation to help explain different programs, and if needed additional strategies can be considered as new ways for health plans and pharmacies to collaborate are established. Future research should attempt to provide even more detailed information on implemented VBI strategies to help guide researchers as well as provide examples for stakeholders to use when designing new VBI programs. Research should continue to understand pharmacists’ perspective of VBI programs. Specifically, better understanding relationships between financial incentives and pharmacist willingness to engage in improving quality performance ratings would be worthwhile in the development of VBI programs. Furthermore, such research might help

elucidate additional ways for health plans to engage with pharmacists which benefit both parties.

Finally, as new VBI programs are identified, research should continue to try to estimate the potential financial impact on retail pharmacies to help pharmacists understand the potential implications on their practice.

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APPENDICES

APPENDIX A: Health Plan Survey

Payer Survey

Q1 Thank you for your interest in the study. We believe your insight will be valuable to understanding how health insurance plans are evaluating and interacting with community

pharmacy practice in response to quality performance measures. Before we begin, please answer the following questions to ensure that you are eligible to complete the survey.

Q2 What is your title within the health plan?

________________________________________________________________

Q3 Approximately how many total lives are covered under your plan?

________________________________________________________________

Q4 Which type of lives does your plan cover? (Click all that apply)

▢

Commercial lives (1)

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Medicare Advantage (MA) lives (2)

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Medicare Advantage with Part D (MA-PD) lives (3)

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Part D only (PD) lives (4)

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Medicaid Managed Care lives (5)

Q6 Using the graphic above, please select all regions where you have covered lives.

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All regions (19)

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Northeast (15)

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South (16)

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Midwest (17)

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West (18)

Q7 Do your job responsibilities include understanding quality performance ratings of the pharmacies within your health plan's network?

o

^{Yes (1)}

o

^{No (2)}

Q8 How knowledgeable are you about whether your plan has considered or implemented various strategies such as pay-for-performance (i.e. bonus payments) or quality-based networks (i.e.

pharmacies included based on performance) to try to boost quality performance ratings from pharmacies within the health plan's network?

o

Extremely knowledgeable (1)

o

Very knowledgeable (2)

o

Moderately knowledgeable (3)

o

Slightly knowledgeable (4)

o

Not knowledgeable at all (5)

(IF RESPONDENT FAILED SCREENER CRITERIA)

Q9 Thank you for taking the time to consider participating in this research. However, you do not appear to meet the criteria to participate, which includes job responsibilities of understanding how your plan evaluates quality performance ratings for pharmacies in your network. If you know of someone that meets this criteria, please consider directing them to this survey. If you feel that you do indeed meet the criteria, please contact the study author, Tristen Jackson, at [email protected], to discuss the possibility of still participating.

(IF RESPONDENT PASSED SCREENER CRITERIA)

Q10 Your responses indicate you are eligible to participate in this study. Please read each of the following 4 pages carefully and answer the questions. Your participation in this study is crucial to understanding how health insurance plans are evaluating pharmacy quality performance

measures and implementing strategies to try to encourage pharmacies to try to improve their own performance.

Q11 Page 1 of 4

Q12 Please carefully read through this brief background of quality performance measures and strategies to boost pharmacy quality performance ratings.

Increasingly, health plans are taking an interest in the quality of care community pharmacies deliver. Quality of care is reflected through specific quality performance measures that are assessed through administrative claims data associated with the pharmacy. While quality measures associated with CMS Star Ratings (i.e. medication adherence for non-insulin diabetes medications) are those most likely to be utilized in measuring pharmacy performance, some plans include additional measures such as percentage of generics products dispensed over brand products (where applicable) or the number of 90 day medication supplies dispensed for chronic

In document Pharmacy value-based incentive programs: an evaluation of health plan strategies, pharmacist attitudes, and financial impact on retail stores (Page 92-142)

CONCLUSIONS & IMPLICATIONS FOR FUTURE RESEARCH

▢

▢

▢

▢

▢

▢ ⊗

▢

▢

▢

▢

o

o

o

o

o

o

o

▢ ^⊗