Abstract
Objective: To use an existing pharmacist-run medication therapy management (MTM)/lifestyle medicine program to propose a new model of reimbursement for pharmacists that is based on pay for performance (P4P) rather than product-based dispensing or fee for service. Data sources: Specific patient outcomes were collected during a 1-year period from an existing pharmacist-run MTM/lifestyle medicine program as the basis to propose this new model of reimbursement. Data synthesis: The proposed model outlines a P4P model of reimbursement for pharmacists that includes both traditional MTM services and patient-centered lifestyle medicine programming. The model uses an all-or-none bundled approach for reimbursement in which the pharmacist is reimbursed at a higher rate if patients achieve all six proposed outcome criteria at 1 year. Pharmacists could earn as much a 43% more income with this model compared with traditional MTM services. This model is an incentive for payers because it is based on patient outcomes and preestablished return on investment models. Conclusion: Pharmacist should begin to explore ways they can participate in a high-performance health care system by moving to a P4P model of reimbursement rather than fee-for-service or product-based dispensing reimbursement models. P4P models of reimbursement could be beneficial to the patient, the payer, and the pharmacist.
| Original language | English |
|---|---|
| Pages (from-to) | 425-431 |
| Number of pages | 7 |
| Journal | Journal of the American Pharmacists Association : JAPhA |
| Volume | 51 |
| Issue number | 3 |
| DOIs | |
| State | Published - 2011 |
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All Science Journal Classification (ASJC) codes
- Pharmacy
- Pharmacology
- Pharmacology (nursing)
- Medicine(all)
Cite this
Pay-for-performance model of medication therapy management in pharmacy practice. / Lenz, Thomas L.; Monaghan, Michael S.
In: Journal of the American Pharmacists Association : JAPhA, Vol. 51, No. 3, 2011, p. 425-431.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Pay-for-performance model of medication therapy management in pharmacy practice
AU - Lenz, Thomas L.
AU - Monaghan, Michael S.
PY - 2011
Y1 - 2011
N2 - Objective: To use an existing pharmacist-run medication therapy management (MTM)/lifestyle medicine program to propose a new model of reimbursement for pharmacists that is based on pay for performance (P4P) rather than product-based dispensing or fee for service. Data sources: Specific patient outcomes were collected during a 1-year period from an existing pharmacist-run MTM/lifestyle medicine program as the basis to propose this new model of reimbursement. Data synthesis: The proposed model outlines a P4P model of reimbursement for pharmacists that includes both traditional MTM services and patient-centered lifestyle medicine programming. The model uses an all-or-none bundled approach for reimbursement in which the pharmacist is reimbursed at a higher rate if patients achieve all six proposed outcome criteria at 1 year. Pharmacists could earn as much a 43% more income with this model compared with traditional MTM services. This model is an incentive for payers because it is based on patient outcomes and preestablished return on investment models. Conclusion: Pharmacist should begin to explore ways they can participate in a high-performance health care system by moving to a P4P model of reimbursement rather than fee-for-service or product-based dispensing reimbursement models. P4P models of reimbursement could be beneficial to the patient, the payer, and the pharmacist.
AB - Objective: To use an existing pharmacist-run medication therapy management (MTM)/lifestyle medicine program to propose a new model of reimbursement for pharmacists that is based on pay for performance (P4P) rather than product-based dispensing or fee for service. Data sources: Specific patient outcomes were collected during a 1-year period from an existing pharmacist-run MTM/lifestyle medicine program as the basis to propose this new model of reimbursement. Data synthesis: The proposed model outlines a P4P model of reimbursement for pharmacists that includes both traditional MTM services and patient-centered lifestyle medicine programming. The model uses an all-or-none bundled approach for reimbursement in which the pharmacist is reimbursed at a higher rate if patients achieve all six proposed outcome criteria at 1 year. Pharmacists could earn as much a 43% more income with this model compared with traditional MTM services. This model is an incentive for payers because it is based on patient outcomes and preestablished return on investment models. Conclusion: Pharmacist should begin to explore ways they can participate in a high-performance health care system by moving to a P4P model of reimbursement rather than fee-for-service or product-based dispensing reimbursement models. P4P models of reimbursement could be beneficial to the patient, the payer, and the pharmacist.
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U2 - 10.1331/JAPhA.2011.10031
DO - 10.1331/JAPhA.2011.10031
M3 - Article
VL - 51
SP - 425
EP - 431
JO - Journal of the American Pharmacists Association : JAPhA
JF - Journal of the American Pharmacists Association : JAPhA
SN - 1544-3191
IS - 3
ER -