A conceptual value-based incentivization model of adult immunization for community pharmacists.

OBJECTIVE: To design a value-based payment model to incentivize pharmacists for increased administration of influenza, herpes zoster, pertussis-containing, and pneumococcal vaccines to adults at community pharmacies. DESIGN: A modified delphi technique was used to create a concept for a value-based payment model through consensus of expert opinion. SETTING: and participants: Experts were recruited from a regional supermarket pharmacy, a self-insured employer, a managed care organization, and an academic institution to participate in 4 electronic surveys and 1 in-person meeting. OUTCOME MEASURES: Consensus on model design by means of a modified delphi technique. RESULTS: A panel of 11 experts participated in a series of electronic surveys and 1 in-person meeting. The final value-based payment model addressed how and when pharmacists would receive an incentive for meeting specific vaccination goals. The final value-based payment model also addressed the following concepts: estimated cost avoidance, vaccine effectiveness, and community protection. A 3-tiered incentive model was agreed on by the participants to tie increased vaccination rates with increased payment. Vaccination goals for each tier were defined as the percent increase in vaccination rates from the year immediately preceding. Incentives were defined as a percentage of estimated direct medical costs avoided to be shared between the payer and pharmacy. CONCLUSION: A conceptual value-based payment model to incentivize pharmacists for increased delivery of adult vaccinations at community pharmacies was designed and agreed on by experts representing a regional supermarket pharmacy, a self-insured employer, a managed care organization, and an academic institution. Consensus was achieved by aligning the interests of both payers and pharmacies. The final model included 3 tiers of bundled incentives to reward percent increases in adult vaccination from historical baselines. This model may be used as an example for community pharmacies and health care payers to design future value-based immunization programs.

Facilitating pandemic influenza vaccination implementation in grocery store chain community pharmacies.

OBJECTIVE: The objective of this study was to determine strategies to implement influenza pandemic vaccinations effectively at grocery store chain community pharmacies. METHODS: Clinical pharmacy coordinators and pharmacy managers representing 3 grocery store chain community pharmacies across Pennsylvania were identified for participation in semistructured telephone interviews. Interviews were audio-recorded and transcribed. Transcripts were independently coded by 2 investigators and coding discrepancies were resolved. A thematic analysis was conducted, and supporting quotes were selected for each theme. RESULTS: Twelve pharmacists participated in the interviews, which were conducted from September 2016 to November 2017. Five key themes were identified: (1) mobilize pharmacy staff members to specific locations to prepare for a high volume of vaccinations; (2) implement vaccination clinics during high-volume scenarios; (3) utilize nonpharmacy spaces to increase vaccination capabilities; (4) determine vaccine distribution by highest risk populations that each pharmacy serves; and (5) conduct training customized to the pharmacy chain that supplements national pandemic influenza training. CONCLUSION: Grocery store chain community pharmacies are desirable sites for pandemic vaccination because of a variety of factors, such as space and staffing flexibility. Developing a pandemic vaccination plan will enable community pharmacists to contribute more effectively during influenza pandemics.

Using prescription dispensing data infographics to facilitate collaborative pharmacist-prescriber discussions on mutual patients.

OBJECTIVE: To develop prescriber-specific infographics containing community pharmacy prescription dispensing data and share them with targeted prescribers to determine their utility in facilitating initial collaborative conversations regarding the care of mutual patients. METHODS: Prescription dispensing data from an independent community pharmacy in western Pennsylvania was collected to generate highly visual infographics for the most frequent prescribers to the pharmacy. Infographics were individualized for prescribers, and they included information on mutual patients between the pharmacy and the prescriber. Infographics were then shared with prescribers during semistructured, audio-recorded interviews. Interview questions elicited feedback on prescriber medication-related needs, quality and performance measures, infographic format and utility, and prescriber-pharmacist collaboration. Interviews were transcribed and coded by 2 independent investigators using qualitative analysis software. Coding discrepancies were resolved. A thematic analysis of the interview data was conducted. RESULTS: Eight interviews were conducted with prescribers. The following themes emerged: (1) the infographic prompted prescribers to recognize potential collaborative opportunities with community pharmacists; (2) the infographic stimulated discussion on prescribing patterns and mutual patient populations; (3) prescribers value discussing the infographic data in a face-to-face meeting; (4) prescribers want to hear from pharmacists when mutual patients have medication-related problems; and (5) the infographic helped prescribers identify quality measures that they were not currently meeting. CONCLUSION: Infographics containing prescription dispensing data for mutual patients may be a useful tool when shared by community pharmacists to facilitate collaborative discussions with prescribers.

An Innovative Approach to Improving the Proposed CMS Star Rating "Statin Use in Persons with Diabetes".

The Statin Use in Persons with Diabetes (SUPD) measure has been adopted by the Centers for Medicare and Medicaid Services as a display measure for Medicare Part C and Part D plan sponsors and is slated for inclusion within the primary star rating measure set. As such, the measure has become a focal point for quality improvement efforts by many health plans. Current pharmacy-based interventions reported in the literature involve pharmacists recommending that a patient's provider issue a prescription for a statin; studies to date have not shown that this intervention has been effective for the majority of patients with diabetes. One innovative option is pharmacist prescriptive authority of statins for patients with diabetes. In such a model, a pharmacist identifies a patient with diabetes who is not on a statin, assesses the patient for contraindications and appropriateness of therapy, and works directly with the patient to close the gap in care. This solution could lead to earlier initiation of statin therapy and reduce the burdens associated with multiple communications with the patient's primary care provider. In 2018, Idaho became the first state to allow pharmacist prescribing to close the SUPD measure, with certain regulatory safeguards in place. DISCLOSURES: No funding supported the writing of this article. The authors have nothing to disclose.

Pharmacist-to-prescriber intervention to close therapeutic gaps for statin use in patients with diabetes: A randomized controlled trial.

OBJECTIVE: To assess the effect of a community pharmacist-led intervention on the proportion of patients with diabetes placed on statin therapy. DESIGN: The Pharmacy Quality Alliance endorsed a performance measure, Statin Use in Persons with Diabetes, which evaluates the percentage of patients aged 40-75 years who were dispensed a medication for diabetes and also received a statin medication. SETTING: This new measure has been implemented within the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) dashboard. PARTICIPANTS: In this randomized controlled study, eligible patients identified in EQuIPP are those who received medications from a large chain community pharmacy in North Carolina, are 40-75 years, had ≥2 prescription fills of a diabetes medication, and were not receiving statin therapy. INTERVENTION: The control group received no intervention. Primary care prescribers of patients in the intervention group were contacted by phone and fax to obtain a prescription for an appropriate statin. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients in each group who were dispensed a statin, calculated using Fisher exact test. Sub-analyses were performed to control for patient age, sex, and insurance type. RESULTS: The number of statins prescribed was statistically significant between intervention group (n = 221) versus control group (n = 199) with 46 statins versus 17 statins, respectively (P <0.001). The number of statins dispensed was also statistically significant between groups with 34 statins in the intervention group versus 15 statins in the control group (P = 0.015). The fourth most common (9.2%) reason prescribers rejected statin therapy initiation was "Patient has normal cholesterol" and this caused the greatest amount of discussion between pharmacist and prescriber. CONCLUSION: Through a brief pharmacist-to-provider intervention, a significant gap closure in statin therapy was seen in patients with diabetes. There is an opportunity for pharmacies, health plans, and prescribers to utilize the community pharmacist in achieving quality, evidence-based patient care.