Payment for Pharmacy Services Flashcards
What three factors determine the quality of pharmacy care?
Structure (aka inputs; people, materials, policy, information, technology)
Process (how the inputs are used)
Outcomes (results achieved from activities employing inputs)
How is the value of pharmacy care determined, broadly speaking?
Quality of care (structural inputs, processes, and outcomes) delivered per cost of care
See slide 4
What are the three main healthcare payment models?
Fee-for-service (paid for goods and services provided)
Salary (paid for the time providing goods and services)
Capitation (paid for number of people enrolled to receive goods and services)
What are some qualities of fee-for-service payment models?
Incentive to provide more goods and services
- Quality of care, beneficial care is left behind
Emphasis on quantity over quality
What are some opportunities and challenges faced by pharmacies with respect to the fee-for-service model?
New clinical services using the FFS model are seen to positively improve patient outcomes (more vaccination, improved adherance, and safe medication use)
Pharmacies are incentivized to prioritize dispensing over other clinical services, as they are more profitable under the FFS model (clinical activities fall to the wayside)
What are some characteristics of the fee-for-service model of healthcare renumeration?
Common method of payment for most HCPs not directly employed by healthcare organizations, including pharmacists
Most community pharmacies use a “buy=and-bill” FFS model with medications purchased from suppliers and dispensed to patients on demand
What are some characteristics of the salary model of healthcare renumeration?
Most common method of renumeration for thoseemployed in public healthcare system, including pharmacists (no financial incentive to provide goods and services)
Community pharmacists themselves also receive salaries, but they are funded by the FFS model (owners incentivized to encourage staff to produce more goods and services, which may cause conflict)
What are some characteristics of the capitation model of healthcare renumeration?
Set dollar amount for each person enrolled/eligible to receive goods and services (patient rolls)
- Surpluses are retained by the provider of goods and services
Often used with family MDs to encourage for preventative care to reduce need for more expensive hospital care
- This model incentivizes fewer services and lowers cost of services (may lead to suboptimal care)
Given the ability of FFS, salary, and capitation renumeration models to affect provider behaviour, what is a novel alternative?
Value-based payment models (usually a combination of FFS and/or capitation + value-based payments)
What are some characteristics of value-based payment models?
AKA performance-based or pay-for-performance (P4P)
The intent is to create an incentive for HCPs to improve patient outcomes while maintaining or decreasing the relative cost of care
Providers are paid for acheiveing outcomes associated with the goods and services provided
What are the results of implementing performance-based payment models?
P4P models are attractive to payers and have seen some success, but there has been little change in quality, cost savings, or clinical outcomes
Outcome measures are often complex due to multiple stakeholders
What are some negative aspects of the performance-based payment models in pharmacy?
Practitioner gaming to maximize revenue
Punishes pharmacies that may be producing positive outcomes for patients from other pharmacies
Can add to health disparities if incentives are for conditions that fail to address the needs of underserved populations
Often fail to reward high performers
What are the concerns of the CPhA towards Green Shield Canada’s attempts to implement a performance-based payment model?
No compelling evidence that P4P initiatives improve patient outcomes or reduce costs (good idea in theory, implementation has been flawed)
Targets fail to consider regional differences
Software to identify pharmacy ratings need to be purchased by the pharmacy
Due to peer comparison, no guarantee of higher reimbursement with improved metrics (get more value without paying more)
