Although the pharmacy profession has evolved over the last several decades, pharmacists remain an untapped resource within the health care industry. Indeed, health plans could see their star ratings improve if they work with pharmacists on innovative programs, says Victoria Losinski, PharmD, Ph.D., MBA, director of portfolio strategy and implementation, Blue Cross and Blue Shield of Minnesota, and a featured speaker at RISE’s upcoming Managed Care Pharmacy Innovation Summit. In this article, Losinski discusses strategies health plans can adopt to work with pharmacists to boost star ratings and health outcomes.
Historically the role of pharmacy has primarily focused on the dispensing of prescriptions. It wasn’t until the mid-1990s that the industry recognized that pharmacists have an incredible wealth of clinical knowledge and could use that expertise to improve the health of every patient they encounter. Since then there has been discussions across the pharmacy profession of what it means to take care of a patient and making sure that pharmacists’ practice at the top of their license. Meanwhile, Losinski says, star ratings have evolved, pushing the industry to consider what does it mean to measure high-quality care in the Medicare population and how can it provide incentives to reward behaviors that encourage the delivery of that high-quality care.
The two movements have created what Losinski describes as a perfect storm that puts pharmacists in a great position to help health plans improve star ratings. “Essentially patients come in contact with their pharmacists far more regularly than they do their physicians. We have great respect from our patients, we are ranked number one or two of the most trusted professions, depending on the year. We have great connection points with members and a wide host of clinical knowledge,” she says.
Health plans, vendors in the star ratings space, and pharmacy benefit managers must now think about what they can do to make sure members get top-notch care at every touch point and how they can connect their members to services they need to ensure they receive the right care at the right time.
“Plans and groups involved in star ratings are trying to be innovative and trying to figure out how to get that edge and stay on the edge and get a 4 ½ - or 5-star ratings. Those that are closer to the pharmacy have figured out this is where they can get the edge in and have more of an impact on measures,” says Losinski, who will discuss the shifting role of pharmacy benefit and impact on star ratings at the Managed Care Pharmacy Innovation Summit, June 20-21, in Chicago.
Pharmacists as health ambassadors
Losinski says that Blue Cross and Blue Shield of Minnesota have pharmacists make appointments with patients when they come to pick up their prescriptions. The pharmacists use the appointments to address gaps of care. For example, if the patients are diabetic, the pharmacists may ask to check their blood sugar, hemoglobin A1c, and may ask about CAHPS and HOS measures related to falls and physical activity and ask whether the medications are working as prescribed. They can even offer vaccinations.
“They really are the health ambassadors within the walls of their pharmacy. So not only are they working on Part D measures, but also the majority of clinical star ratings measures to see how well medications are working in a lot of instances, if their blood pressure is under control, if their A1c is in control, and making sure the patients have what they need to be healthy and successful in their lives,” she says. “The closer we can get to the pharmacy and tap into that resource, we will see performance skyrocket.”
Blue Cross and Blue Shield of Minnesota considers the pharmacist as the medication expert on the health care team and encourages their members to go over their medications with the pharmacists to make sure everything is appropriate, effective, safe and they adhere to it. “That’s essentially what star ratings are asking us to do. We want to make sure the therapy treatments are appropriate, safe, and patients are taking the medication as intended. That type of conversation with patients has been hugely impactful,” says Losinski, who notes that pharmacists can play a role in helping to decrease hospitalizations by making sure the medication they are taking aren’t excessive and are the appropriate dosages.
Pharmacists can improve the member experience
“That is what the pharmacists of today were trained to do,” she says. “Tapping into that just gives us a better member experience and helps us think about, not only what that interaction will do today, but what that interaction will have on the patient’s future health.”
She suggests that health plans and PBMs work with the big pharmacy retail chains about how they can best maximize the pharmacist’s time with the patient to have a greater impact on the patient’s health. “The evolution can only happen when a health plan and PBM incentivizes providers to move in that direction. Part of that comes from the star ratings program and asking, how can we have you help us improve patient care around star ratings and looking for partners who are ready to engage. We need to have those conversations and ask what we can do to optimize the pharmacist workload to get the most of those interactions and what can we really do to make sure pharmacists are practicing at the top of license.”
To begin, she suggests health plans and PBMs ask the right questions. “You could say, we are interested in improving star ratings. Tell me how you can help me improve MTM rates. Part of this is holding to standards and making sure that you partner with people who are interested in providing high-quality care. And you need a clear picture as to what that high-quality looks like and then determine, how are we going to measure it and how am I going to make sure that you are rewarded for making sure that your teams perform to those measures.”
You can learn more about the results of Blue Cross and Blue Shield of Minnesota’s pharmacist-driven MTM programs and the effects it had on star ratings during Losinski’s featured presentation at the Managed Care Pharmacy Innovation Summit. For the complete agenda, click here.