Grant Title: A Framework for the Quantification of Community Pharmacy Contribution to Management of Total Medical Expenditure
Grants Awarded Number
Grant Complete, 2015
Cambridge, Massachusetts
Grant Category
Profession, Academics & Economics
Pharmacy Services, Quantification
Grant Docs
Framework - Discussion Draft
As reimbursement for health care providers physician practices, hospital systems increasingly migrates away from fee for service to budgeted andor performance-based reimbursement, the value and even the necessity of clinical pharmacy services is becoming more apparent. What might be called a first generation of payment goals for providers is heavily tied to population health management goals such as hypertension, diabetesglucose management, etc. that require medication therapy. Many payers and providers target highly complex and high risk patients for intervention, patients who are highly likely to be on multiple medications. Yet compensation for pharmacy services, particularly clinical andor cognitive services, for these patients remains haphazard, inconsistent and rare. Little of the supportive literature on community pharmacys contribution to medical spending management has been conducted in the context of all the capabilities now available to both prescribers and community pharmacists, such as e-prescribing, patient targeting backed by sophisticated analytics, and the use of patient engagement tools. To that end, we propose to conduct a short term project that will identify key factors in coordinated medication management by community pharmacists in the context of todays payment drivers such as ACO goals and outline the steps necessary to convert the framework into econometric modeling that will yield robust measures of the community pharmacys contribution to reduction or control of Total Medical Expenditure for targeted patients.
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  • Applicant:
    Thomas Hubbard