An Evaluation of Community Pharmacies’ Actions under Value-Based Payment

Abstract Objective To determine actions taken by community pharmacies to be successful under a value-based pharmacy program (VBPP). Method An exploratory sequential mixed methods approach was used to evaluate pharmacies participating in the VBPP, with qualitative data collected and analyzed in the first phase, followed by quantitative measurement through a 30-item survey instrument in the second phase. Results The qualitative data showed that pharmacies were more involved with adherence, cardiovascular and diabetes metrics in comparison to others. Depression metrics received the lowest overall involvement. For total cost of care, different approaches were used; five pharmacies used the dashboard to identify likely high cost patients they could try to manage, and four pharmacies monitored adherence to avoid complications that could contribute to increased cost. For the survey response rate was 72.6% (n=53). The mean perception of level of success was 53.06 ± 20.15. Activities with the highest priority were adherence (1.98 ± 0.97) and diabetes care (2.04 ± 0.83) and the lowest was depression care (3.60 ± 1.10). The most frequently mentioned challenge was time availability and the most common improvement suggestion was better communication between the insurer and providers. Conclusion In conclusion, this study found that community pharmacies were transforming their practices to be successful under a value-based payment program. The pharmacies tended to build on care processes already established (e.g. medication adherence, patients with diabetes and/or cardiovascular conditions) and developed new processes to address emerging metrics and associated patient needs (e.g. collecting and documenting BP and HbA1c levels). Future research is needed to identify best practices for patient care and pharmacy success under broad value-based pharmacy programs like the one studied here.