Making the economic value proposition for pharmacist comprehensive medication management (CMM) in primary care: A conceptual framework
| Autor: | Benjamin Y. Urick, Sachiko Ozawa, Jon C. Easter, Kristen Tripicchio |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Primary Health Care
Medication Therapy Management Value proposition 010102 general mathematics Pharmacist Pharmaceutical Science Fee-for-Service Plans Pharmacy Pharmacists 01 natural sciences Clinical pharmacy 03 medical and health sciences 0302 clinical medicine Patient satisfaction Conceptual framework Patient Satisfaction Humans Operations management 030212 general & internal medicine Business plan Business 0101 mathematics health care economics and organizations Reimbursement Accreditation |
| Zdroj: | Research in Social and Administrative Pharmacy. 16:1416-1421 |
| ISSN: | 1551-7411 |
| DOI: | 10.1016/j.sapharm.2020.01.001 |
| Popis: | Introduction Comprehensive medication management (CMM) is a patient care process provided by clinical pharmacists in primary care settings that ensures optimal use of medications with timely follow-up. Despite widespread evidence that shows CMM improves clinical and medication-related outcomes, pharmacist-delivered CMM services often fail to be adopted into U.S. primary care settings. Objective This study presents a conceptual framework linking outcomes of pharmacist-delivered CMM services in primary care settings to financial benefits for health plans providing coverage of CMM services and primary care practices investing and implementing CMM. Methods A critical review of the literature was performed in PubMed and the gray literature to identify financing opportunities that justify the coverage of CMM by third-party health plan administrators or the implementation of CMM by primary care practices. Financing elements that could be impacted by pharmacist-led CMM outcomes, namely higher achievement of medication-related quality measures and reduction of total costs of care, were recorded and utilized to develop the conceptual framework. Results The framework suggests that CMM provides economic benefits to both health plans and primary care practices by increasing market competitiveness, direct revenue, and quality bonuses. Health plans may benefit from higher plan quality ratings, lower premiums and plan bids, increased shared savings, and quality bonus payments. Primary care practices may achieve increased negotiating power through accreditation recognition and patient satisfaction, increased revenue through shared savings and fee-for-service reimbursement, and achievement of quality bonus payments. Conclusions The alignment of economic benefits from CMM advances a strong value proposition for greater adoption of CMM coverage by health plans and implementation in the U.S. primary care system. Through broader CMM implementation, pharmacists can work alongside physicians in advanced care models and play a vital role in shaping the primary care practice transition to value-based care. |
| Databáze: | OpenAIRE |
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