Forging a novel provider and payer partnership in Wisconsin to compensate pharmacists for quality-driven pharmacy and medication therapy management services

J Am Pharm Assoc (2003). Sep-Oct 2009;49(5):642-51. doi: 10.1331/JAPhA.2009.08158.

Abstract

Objective: To describe the Wisconsin Pharmacy Quality Collaborative (WPQC), a quality-based network of pharmacies and payers with the common goals of improving medication use and safety, reducing health care costs for payers and patients, and increasing professional recognition and compensation for pharmacist-provided services.

Setting: Wisconsin between 2006 and 2009.

Practice description: Community (independent, chain, and health-system) pharmacies and private and public health care payers/purchasers with support from the McKesson Corporation.

Practice innovation: This initiative aligns incentives for pharmacies and payers through implementation of 12 quality-based pharmacy requirements as conditions of pharmacy participation in a practice-advancement pilot. Payers compensate network pharmacies that meet the quality-based requirements for two levels of pharmacy professional services (level 1, intervention-based services; level 2, comprehensive medication review and assessment services).

Main outcome measures: The pilot project is designed to measure the following outcomes: medication-use quality improvements, frequency and types of services provided, drug therapy problems, patient safety, cost savings, identification of factors that facilitate pharmacist participation, and patient satisfaction.

Results: The Pharmacy Society of Wisconsin created the WPQC network, which consists of 53 pharmacies, 106 trained pharmacists, 45 student pharmacists, 6 pharmacy technicians, and 2 initial payers. A quality assurance process is followed approximately quarterly to audit the 12 network quality requirements. An evaluation of this collaboration is being conducted.

Conclusion: This program demonstrates that collaboration among payers and pharmacists is possible and can result in the development of an incentive-aligned program that stresses quality patient care, standardized services, and professional service compensation for pharmacists. This combination of a quality-based credentialing process with a professional services reimbursement schedule is unique and has the promise to enhance the ambulatory pharmacy practice model.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Community Pharmacy Services / economics*
  • Cooperative Behavior*
  • Health Plan Implementation / methods
  • Humans
  • Medication Therapy Management / economics*
  • Pilot Projects
  • Program Evaluation
  • Quality Assurance, Health Care* / economics
  • Reimbursement Mechanisms / economics*
  • Wisconsin