Collaborative Practice Flashcards
Explain Value Based Contracts
instead of counting the number of pills, injections, procedures are administered, the outcome of these administrations are monitored
What are value based contracts?
risk-sharing agreements between manufactures and payers, pharmacy benefit managers or health systems that tie rebates and payment to outcomes
Who benefits from VBCs?
payers (reduce liability)
manufactures (the potential to gain market access)
patients (greater access to medications)
What is the difference between fee-for service and value based contracts?
fee-for service: paid each time healthcare is performed
value based contract: paid based on an agreed upon value-based outcome
What are key performance indicators?
quantifiable measures of quality that can be used to track an organization’s progress toward achieving intended goals related to process inputs, process outputs, or outcomes
- have been approved to provide a positive outcome
What is a process measure?
“a health-care related activity performed for, on behalf of or by a patient”
What is an outcome measure?
“a health state of a patient resulting from health care”
What are examples of Key Performance Indicators for Community Pharmacists?
- Medication Management
- Outpatient pharmacist-based clinics
- Utilization Management
- Pharmacy based Disease State Management or Chronic Condition Management
What are operational measures?
measurement of how long a patient is on hold when calling a plan and how enrollees rate a plan
What are provider measures?
several measures focus on the quality of care provided by a Medicare plan’s providers (especially doctors)
What are medication-use related measures?
these are weighted heavily, as performance on pharmacy measures can impact up to 50% of a Medicare PDP’s overall Star Rating
What are the goals of PHM?
- keeping patients healthy
- Reducing health risk
- Assuring appropriate care for people who are already sick
