AccessHealth demos new suite of tools to help optimize managed care performance

McKesson’s AccessHealth, a market leader in managed care solutions, is showcasing a number of enhancements at McKesson ideaShare 2016 designed to help enable independent pharmacies to gain access to — and compete in — the right preferred networks.



AccessHealth hosted a special sunrise educational session Tuesday morning, at McKesson ideaShare, where two executives from CVS Health talked about the types of activities and outcomes payers are looking for from independent pharmacies in order to maximize performance reimbursements opportunities.  In addition, AccessHealth team members were on hand in the McKesson ideaShare exhibit hall to walk attendees through the new enhancements.



But to get a first-hand understanding of how AccessHealth’s contracting and performance programs help independent pharmacy operators understand and navigate the managed care landscape, deliver best-in-class medication-related performance outcomes and optimize reimbursement, Drug Store News caught up with AccessHealth VP and general manager Eyad Farah and director, pharmacy performance Amie Bland in an exclusive pre-ideaShare interview.



“The narrow networks are not going to go away,” Farah told DSN. “They’ve proven successful in doing exactly what they’re supposed to do, reducing overall costs for payers and the PBMs.” This has been an interesting year, Farah explained, “because we’re starting to see more and more of these limited networks within the commercial and the Medicaid space,” which represents about two-thirds of the prescription volume for pharmacies participating in AccessHealth, he said.



Among the recent enhancements to the AccessHealth platform is the Pharmacy Performance Guidebook. Introduced earlier this year, the Pharmacy Performance Guidebook helps McKesson customers understand the overall performance focus of each PBM or plan, and offers detailed instructions for developing action plans to improve patient behavior and boost outcomes through such tools as medication therapy management, refill reminders, medication synchronization and behavioral coaching.



“As all of health care continues to move to a value-based payment model,” Farah said, “it’s becoming increasingly more important for community pharmacies to incorporate performance measures into their practices. Very similar to how performance models have grown in the last couple years, we’re going to see that move toward [limited] performance networks,” Farah said.  



“This is the year our pharmacists have more opportunities to obtain performance dollars than any other year we’ve seen,” added Bland. “In 2016, we’re seeing medication therapy management completion activity fees, bonus payments and now variable direct and indirect remuneration fees, so the actual reimbursements can be improved by elevating top performance.”



Direct and indirect remuneration (DIR) is a fee system, originally created by the Centers for Medicare and Medicaid Services and subsequently adopted by private payers, designed to lower costs and improve outcomes for patients. DIR fees are collected at varying times throughout the year, so anticipating and planning for them is critically important for pharmacy operators.



Pharmacies that meet the top PBM performance requirements may be charged a smaller DIR amount than those who underperform, Farah explained. “In 2016, about 40% of AccessHealth Medicare Part D claims had that variable DIR opportunity,” he said. In 2015, there were relatively none.

 

To help independent pharmacy operators maximize the variable DIR opportunity, AccessHealth also recently added the DIR Estimator Tool to its suite of tools. The DIR Estimator Tool helps estimate accrual and incentive amounts that could impact DIR payments.



After McKesson ideaShare, AccessHealth will be introducing a performance estimator tool that “will help stores identify all the performance opportunities they have available to them — for instance, if there are MTM activity fees available or PBMs that are offering the variable DIR rates,” Bland said. “There’s even a partnership within McKesson that’s offering rebates. So, the new estimator tool will highlight all the various performance reimbursement opportunities in one place for our pharmacies.”



Earlier this year, AccessHealth augmented its McKesson Reimbursement Advantage program with the launch of MRA+, which integrates PrescribeWellness Patient Engagement Center and Medication Synchronization Solution, StarWellness in the MRA program.  MRA+ helps pharmacies tap into their performance opportunities and provides a dedicated coach to assist pharmacies on their performance journey, Bland explained. “Our MRA and MRA+ stores have higher performance scores than those that are not enrolled in these programs,” Bland said. “They have constant reinforcement of the importance of pharmacy performance.”



Currently, more than 5,700 small and medium chain pharmacies are members of AccessHealth.