Escalating costs are shifting our health care economy from traditional fee-for-service to value-based payment models. Affordable Care Act incentives have made quality improvement with cost reduction a health care imperative. Payer focus on health outcomes for entire patient populations is driving change in health care delivery.
Rather than simply caring for individual patients who actively seek care, health professionals must be equipped to care proactively for entire populations and will be compensated accordingly — for outcomes achieved, rather than services delivered.
Success in this new value-based landscape of population health management requires aligning with strategic partners, harnessing and analyzing more data, and prioritizing value in the allocation of limited health care resources.
Pharmacies that have successfully adopted the appointment-based model enjoy a distinct advantage in population health management implementation to the extent that they have already employed tools to manage subsets of their patient population and target specific patients who require intervention.
The efficiency-multiplying effect of automated appointment-based medication synchronization is the single most influential tool in building capacity for patient care. Population health management success depends on knowing which patients need care the most and optimizing care capacity to intervene as needed, thereby improving outcomes, lowering costs and driving pharmacy profitability in the new health care economy.
Technology, improved data use, automation and innovation are essential to pharmacy’s patient care future.
Patients’ needs vary considerably by age, disease state, comorbidities, behavioral health, environmental conditions, genetic mutations and a multitude of other factors. Pharmacy must utilize predictive analytics to drive risk-based population stratification and identify patients for whom intervention will make the greatest impact, both clinically and financially. They must have actionable data pertinent to the nature and timing of patient-specific interventions.
While population health management is not intended to be specific to chronic care, patients who stand to gain the greatest benefit from pharmacy-based Population Health Management tend to have comorbidities requiring chronic care.
Trove of patient data
Ateb’s pharmacy partners have enrolled over 1 million patients in its Time My Meds automated, appointment-based medication synchronization programs. In turn, Ateb has been able to study this population to examine patient behavior patterns and identify better ways for pharmacy to intervene with patients to achieve better outcomes.
Ateb’s big data and analytics team constantly analyzes and studies the wealth of data collected with its pharmacy partners. Ateb works with its pharmacy partners to deploy pharmacy-based patient care solutions and the predictive analytics to drive pharmacy outcomes by improving their performance as measured through patient outcomes and profitability.
Furthermore, data analysis reveals visibility of lapsed patients for whom development of retention strategies will be increasingly important, both from a quality performance and a business perspective. High-impact patient targeting and intervention will improve pharmacy business performance by improving PDC (proportion of days covered) scores, maximizing reimbursement, and reducing DIR (direct and indirect remuneration) fees.
By contracting with health plans and self-funded employers to engage community pharmacies in pay-for-performance programs, Ateb is helping pharmacy maximize reimbursement within existing payment channels, and generate new revenue channels in preparation for success in a value-based payment system. Pharmacies are rewarded for payer quality-measure performance improvement based on outcomes achieved.
Business and analytics
Ateb’s business intelligence and analytics capabilities enable pharmacies to harness the power of their data. Having insight to understand performance is essential, but even more important is having the solutions to correct underperformance.
Ateb’s consultative approach helps pharmacies to make informed decisions regarding the best tools for their patient care arsenal, the right service mix, and the best approaches for attracting new customers, retaining existing customers, and identifying and recovering patients who may have lapses in their medication usage. Ateb’s Patient Management Access Portal provides access via integration to Mirixa MTM cases, Pharmacy Quality Solutions’ (PQS’) EQuIPP platform, and iMedicare, as well as Ateb’s solutions, all of which enable Ateb’s pharmacy partners using its data insights to address broad health initiatives, including:
• Transitional care programs — Utilize bidirectional data flow between hospitals and community pharmacies through Ateb’s Hospital Exchange to ensure targeted patients receive medication reconciliation and high-touch transition post-discharge; pharmacies help hospitals reduce preventable 30-day readmissions.
• Immunization — Ateb identifies and prioritizes patients who should receive vaccinations through Outbound and Inbound Awareness Messaging and integrate with state registries including both query and reporting to the registries. The integration is real-time for states that offer real-time reporting.
• Population health management — With Ateb’s data integration, communication, analytics and reporting capabilities, Ateb’s PHM solution allows identification of patient subpopulations, risk stratification, intervention identification, patient engagement, care management and outcomes measurement.
• Pharmacogenomics (PGx) — Ateb’s pharmacy partners are able to tailor the right medication and dosing regimen to a patient’s individual genetic makeup. Ateb’s PGx solution identifies high-impact patients and enables pharmacy to operationalize PGx or precision medicine services efficiently into the pharmacy work flow.
• Disease management programs — Reside in Ateb’s PMAP to help the pharmacy engage patients and ensure compliance with standards of care in the management of chronic health conditions and prevention-focused healthy living programs anchored in patient adherence through appointment-based medication synchronization.
Pharmacies’ position in the health care ecosystem, their access to the patients and their ability to take rapid action against the data available to them will allow pharmacy to evolve as a key party in solving the need for accessible, affordable and quality health care.
Rebecca Chater, R.Ph., M.P.H., FAPhA, is executive health care strategist at Ateb Inc.