McKesson AccessHealth enhances suite of reimbursement tools
SAN FRANCISCO - Investing in the continued success of independent pharmacies, McKesson AccessHealth on Wednesday expanded its suite of reimbursement and performance enhancement tools and relationships.
“While the shift to preferred networks and new reimbursement models is challenging for many independents, there are also opportunities for incentives, and we are preparing our members to take advantage of them," stated Eyad Farah, VP business development and strategy. "There is a tremendous chance for innovative pharmacies to leverage their strengths, improve their overall pharmacy performance and maximize their reimbursement by interacting with their patients and providing care.”
It is estimated that in 2016, more than one-third of Medicare D claims through AccessHealth contracts will include performance-based reimbursement incentives. This means that as an incentive for top performance, those pharmacies or pharmacy networks who display top performance will be charged a smaller DIR, or Direct and Indirect Remuneration, amount than those who underperform. This evolution presents independent pharmacies with an enormous opportunity to reduce their DIR charges, thereby maximizing their potential reimbursement.
While DIRs are not new to the market, DIR performance opportunities are. In previous years, pharmacies were charged a specific DIR amount with no opportunity to improve upon the amount. This represents a significant shift in the DIR landscape with a transition toward DIR performance opportunities in 2016.
The new suite of tools include:
AccessHealth Pharmacy Performance Guidebook Building on the comprehensive Medicare Part D Reimbursement and Performance Guide introduced in November, the Pharmacy Performance Guidebook helps members understand the overall performance focus of each PBM or plan. Overall performance scores are impacted by the ability to positively influence patients’ health outcomes, and the Guidebook offers detailed instructions on how to develop action plans to improve patient behavior and boost outcomes using such tools as medication therapy management (MTM) case completion, refill reminder programs, medication synchronization and behavioral coaching;
AccessHealth DIR Estimator Tool DIR is a term used by the Centers for Medicare and Medicaid Services for price concessions related to the Medicare benefit, and DIR fees are typically used to lower patient cost or improve patients’ health outcomes. DIR fees are collected at varying times throughout the calendar year, so it is important for a pharmacy to consider anticipating and planning for this collection in advance. The new AccessHealth DIR Estimator Tool allows a pharmacy to enter information specific to them and estimate accrual and incentive amounts that may impact DIR payments in order to plan accordingly; and
AccessHealth Webinar Series AccessHealth hosted a series of webinars designed to help independent pharmacies prepare for new reimbursement rates as well as identify opportunities to leverage the movement toward pay-for-performance incentives. The most recent webinar, “Optimizing Pharmacy Performance” (Dec. 10, 2015), featured an in-depth overview of the 2016 operational and clinical performance requirements of preferred networks and specific strategies for successfully maneuvering preferred networks. Recordings of all of the AccessHealth webinars, including “What to Expect for 2016 Medicare Part D” and “AccessHealth 2016 Medicare Part D Reimbursement and Performance Guide” are available on the Managed Care tab of McKesson Connect or mypharmacy.mckesson.com.
AccessHealth is the managed care solution for more than 5,500 small and medium chain pharmacies, nationwide.