Table of Contents
SAN FRANCISCO — McKesson AccessHealth has expanded its suite of reimbursement and performance enhancement solutions for community pharmacies.
The company said that with pharmacy reimbursement models focusing more on clinical performance and patient health outcomes, it has worked with other industry leaders to develop tools, resources and webinars to help community pharmacies to improve patients’ results and optimize reimbursement.
This year, McKesson AccessHealth noted, over a third of Medicare D claims through AccessHealth contracts will include performance-based reimbursement incentives. So as an incentive for top performance, pharmacies or pharmacy networks that display top performance will be charged a smaller DIR (direct and indirect remuneration) amount than those who underperform.
This presents independent pharmacies with a significant opportunity to rein in their DIR charges and boost their reimbursement, according to McKesson AccessHealth, which noted that DIR performance opportunities are new to the market. In previous years, pharmacies were charged a specific DIR amount but had no opportunity to improve on the amount, the company said.
“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,” stated Eyad Farah, vice president of business development and strategy at 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.”
Key tools and resources from McKesson AccessHealth include the AccessHealth Pharmacy Performance Guidebook, AccessHealth DIR Estimator Tool and AccessHealth Webinar series.
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 improve outcomes, using such tools as medication therapy management (MTM) case completion, refill reminder programs, medication synchronization and behavioral coaching.
DIR fees are collected at varying times throughout the calendar year, so it’s important for a pharmacy to consider anticipating and planning for this collection in advance, McKesson AccessHealth said. The new AccessHealth DIR Estimator Tool enables pharmacies to enter information specific to them and estimate accrual and incentive amounts that may impact DIR payments, allowing them to plan accordingly.
AccessHealth has hosted webinars to help independent pharmacies prepare for new reimbursement rates as well as identify opportunities to leverage the movement toward pay-for-performance incentives. Its most recent webinar, “Optimizing Pharmacy Performance,” featured an in-depth overview of the 2016 operational and clinical performance requirements of preferred networks and specific strategies for 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 at mypharmacy.mckesson.com.
In addition, AccessHealth has invested in partnerships to help develop performance solutions for member pharmacies. These include EQUIPP, a performance information management platform offered by Pharmacy Quality Solutions (PQS); the StarWellness medication synchronization software tool from PrescribeWellness; Mirixa MTM and targeted patient-care services; and the McKesson Reimbursement Advantage (MRA) and McKesson Reimbursement Advantage Plus programs, which help pharmacies tap into their performance opportunities and provide a dedicated coach for assistance.
AccessHealth provides managed care solutions for more than 5,500 small and midsize chain pharmacies nationwide.
