Keeping up with all the communications and information from multiple payers is daunting. One of the most crucial pieces of information a pharmacy receives from the Pharmacy Benefit Managers (PBM) is the performance reports. Although frequently challenging to find and difficult to interpret, a pharmacy needs to understand gaps in clinical care that may impact contract performance. These reports provide crucial insight into the clinical metrics that drive DIR fees and program incentive payments throughout the year. Your best solution is to have a Pharmacy Service Administration Organization (PSAO) that can give you clarity and guide you through these reports.
Pharmacies rely on PBM reports to understand their performance metrics. However, PBM reports often vary in how they are distributed and formatted, making it difficult for pharmacies to identify essential information. Some payer reports may not include detailed adherence data for a pharmacy, creating difficulty in identifying areas of improvement for their daily operations. An experienced PSAO can help pharmacies locate reports and provide additional insight for analyzing their performance.
The phrase “Direct and Indirect Remuneration (DIR) fee” is frequently used in pharmacy reporting. A pharmacist would expect this term to be easily identified in a report used to determine the financial impact on their business. However, PBMs will often use their own specific terminology to identify DIR fees in their reports. DIR fees can be referred to as a Contingent Medication Adherence Performance Fee, a Network Variable Rate, or whatever the PBM calls it. Make sure you select a PSAO partner that helps you understand the contract terminology utilized by PBMs.
A pharmacy has located its reports and now understands the language within them. How do they interpret the data? Understanding the impact results have on a pharmacy is key to creating an action plan. Reports can be delivered in a basic spreadsheet-type grid or even a mess of colors and highlighted tables that use confusing metrics. Utilizing a PSAO with a dedicated on-staff performance team can provide pharmacies the additional help necessary to fully understand their reports. They can also assist in simplifying reporting metrics or even streamline calculation processes that reduce the legwork needed to identify potential financial impact.
Deciphering a DIR fee report loaded with adherence metrics is an achievement. However, being able to act on the report information is the only way to improve a pharmacy’s metrics. Creating an action plan with measurable solutions is the most integral step in understanding reports. Pharmacies want to create plans that will enhance their financial health while making the best use of their already limited time. Quality monitoring programs like EQuIPP® and OutcomesMTM® provide streamlined platforms that can help pharmacies increase their quality metrics to help minimize their DIR fees and maximize their reimbursements. Make sure you partner with a PSAO that understands your goals and recommends the programs that best align with your business needs.
In today’s pharmacy landscape, it is not always enough for a PSAO to simply assist pharmacies in need. A dedicated PSAO will work to leverage the success of its high-performing member pharmacies to identify and share successful methods that benefit all pharmacies. By providing pharmacies with direct access to a contracting team and clinical pharmacist that can offer insight into payer reporting and analysis, Pharmacy First provides member pharmacies with the tools necessary to create an action plan for success. If your store would benefit from additional reporting assistance, please contact us today at firstname.lastname@example.org to learn more about how Pharmacy First can help support your success.
About the Author
Dalton Thompson, PharmD, is the Manager, Pharmacy Programs for Pharmacy First with almost 10 years of pharmacy experience. His experience began in retail pharmacy and his passion for helping patients within the healthcare system brought him to managed care. His past experience in the U.S. Air Force Reserves has instilled in him meticulous attention to detail when assisting patients and pharmacists alike.