Selective access: Elevate Provider Network selects the right preferred networks

Above: Elevate Provider Network Vice President Peter Kounelis and Managed Care Director Rick McKaig present the continuing education session “The Motive Behind the Madness: Managing Drug Spend and Trend” at Good Neighbor Pharmacy ThoughtSpot 2016.

As reimbursements and profit margins in independent pharmacies shrink, one of the main ways pharmacy services administrative organizations (PSAO) have sought to help their pharmacy partners provide better health outcomes to their patients, while ensuring pharmacies are reimbursed for their services, is through participation in preferred cost-sharing networks.  



But, not all preferred networks are created equal, according to AmerisourceBergen Vice President of Elevate Provider Network Peter Kounelis, and the networks that PSAOs participate in can have a real impact on their members’ ability to provide better outcomes.



At Good Neighbor Pharmacy’s ThoughtSpot 2016, Kounelis told Drug Store News that, while other PSAOs take an approach that encourages participation in every preferred network, Elevate Provider Network takes a more measured approach because it has the pharmacists — and patient care they need to provide — in mind.



Conversations about preferred networks tend to revolve around access to patients, and the potential loss of business that would result in not participating in a particular preferred network. But according to Kounelis — who also helped lead a continuing education session alongside Elevate Provider Network’s Managed Care Director Rick McKaig about preferred networks and reimbursement — to say participation in preferred networks is the only way some pharmacies can have access to patients is to ignore the role patient care can play in retaining customers.



“What a lot of our competitors have done is conflate the notion of access to patients with participation in a preferred cost-share network,” Kounelis said. “[But] access to patients remains no matter what — it’s just a question of incentives and disincentives provided to patients to either remain or switch pharmacies. If you're doing all the right things — including taking the time to counsel your patients, improve their adherence and answer all their questions — it would be infinitely more difficult for a co-pay incentive to get them to leave your pharmacy. … Being in every preferred network would, at some point, rob the pharmacist of the resources, the time and the ability to take care of the patients they currently treat.”



Elevate Provider Network’s focus on ensuring its 4,500 pharmacy members are able to provide the best care for their patients is what informs the PSAO when it assesses whether it will participate in a preferred network. Armed with the claim-level data that drives Elevate Provider Network, Kounelis said his team looks at plans holistically — from DIR fees to generic effective rate, and from average wholesale price discount rates to dispensing fees — because it’s a process that pharmacists and their patients can’t afford to have working to their disadvantage.



“It’s a strategy that’s essentially a risk — a gamble so to speak,” Kounelis said. “You’re betting that the concessions you’re giving to participate in some of these networks will be at least offset by the incremental patients and prescription volume that comes to your store, and when it isn’t, essentially you’ve lost the bet.”



Instead of choosing to bet on every preferred network, Elevate Provider Network is choosing to bet on its member pharmacies’ ability to provide exceptional patient care while participating in plans that will allow the patient care that differentiates independent pharmacies.



“The independent pharmacy is a business. They offer valuable services, and they should be compensated according to the overall healthcare value that they deliver,” Kounelis said. “We believe our strategy differentiates and points to the independent pharmacy to play on their strengths where they have the biggest ability to deliver value to the healthcare system by improving the lives of their patients.”