A new program that aims to move community pharmacies away from a transactional relationship with payors to a shared accountability for patient health outcomes is underway, beginning with measuring performance.
Moving toward a value-based system is key because Canada currently spends more per capita on health care, on average, than any other country in the Organisation for Economic Co-operation and Development, with large variations in the quality of service delivery, said Ned Pojskic, Green Shield Canada’s leader of pharmacy and health provider relations, during a session at the 2018 Pharmacy Solutions in Drug Plan Management forum in Mississauga, Ont. on Sept. 25.
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In Britain and the United States, for example, successful pay-for-performance schemes are already in place for physicians and pharmacies, with results publicly reported, said Pojskic. In Canada, the health-care system is moving rapidly in this direction, he added, noting that Ontario passed an act in 2010 that paves the way for quality improvement in hospitals, including the requirement to have an annual quality improvement plan and executive compensation tied to meeting these targets.
However, while all provinces have quality improvement councils tasked with measuring performance in the health-care system, pharmacy hasn’t been included in any of these to date, said Pojskic.
“We have a situation where our entire health-care system is shifting away from hospitals, from care within institutions to the community and we don’t have pharmacy as the primary [medication] provider involved in these quality assessment frameworks? That’s a huge oversight and something that needs to change.”
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As such, value-based pharmacy, the first system in Canada to measure the performance of all 10,000 pharmacies across the country, was launched in late 2017. Derived from a U.S. system developed more than a decade ago, the initiative involves eight different medication-use quality measures that make up the assessment framework, said Pojskic.
The first three are related to medication adherence — specifically hypertension, cholesterol and diabetes drugs — and establish a metric as to whether all of the patients at a particular pharmacy are refilling their medication in a timely manner. Other measures examine disease management, specifically the usage of statins for patients over age 45 with diabetes. Two further measures look at asthma management, including how well asthmatic patients are being managed in terms of their medication therapy.
Finally, the system looks at the completion rate of the pharmacist health coaching program, as well as a patient safety measure, namely, high risk medication use in the elderly, said Pojskic.
The measures, chosen because they address high-priority areas in the health-care system, can be impacted by pharmacist activities and are also easy to understand, track and improve, he noted.
In helping to structure the system, Green Shield Canada worked with Pharmacy Quality Solutions, a U.S.-based provider of medication-use assessment services, which serves more than 37 million Medicare recipients.
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The Canadian program is launching in three phases, said Pojskic, with the first — performance reflection — already underway. Since October 2017, community pharmacies have been receiving reports in the mail or online, detailing their performance on these measures. The patient impact scorecard, he noted, provides pharmacies with a score unique to their location relative to the goal and to peers in their province.
The second phase of the program will be a provider search tool where plan members will be able to search for pharmacies on the basis of their quality-of-care score. And lastly, the first pay-for performance system in Canada will be implemented for community pharmacies across the country, beginning in 2020, according to Pojskic.
The new system, he explained, wasn’t designed as a cost containment initiative, but will reward high-performing pharmacies with bonus payments and penalize low performers, both of which are important for moving the profession forward.
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“This wasn’t a system to take money out of pharmacy,” said Pojskic. “It’s a system to better incentivize performance. In other words, to better align performance with financial reimbursement.”
He also noted that Green Shield Canada is working closely with the Canadian Pharmacists Association on the initiative, and the pharmacy community has generally embraced the change.
Read more articles from the 2018 Pharmacy Solutions in Drug Plan Management Forum