How Performance Management can Improve Your Performance Metrics

To improve your community pharmacy’s reimbursement rates with PBMs and insurance companies. Reimbursements can be heavily affected by your pharmacy’s performance and patient adherence. To help improve reimbursements through certain plans it’s crucial to focus on key performance metrics that demonstrate your pharmacy’s value in terms of patient outcomes, efficiency, and adherence to quality standards. Here are some key performance metrics to consider:

1. Medication Adherence Rates: High adherence rates indicate that patients are taking their medications as prescribed, which can lead to better health outcomes and lower overall healthcare costs. This is a critical metric for payors as it directly impacts on their cost savings.
2. Medication Therapy Management (MTM) Services: Offering comprehensive MTM services can help identify and resolve medication-related issues, improve patient outcomes, and reduce healthcare costs. Tracking the number and outcomes of MTM interventions can showcase your pharmacy’s proactive role in patient care.
3. Generic Substitution Rate: A high rate of generic substitutions can demonstrate cost-effectiveness, which is attractive to PBMs and insurers. This metric shows your commitment to providing cost-effective medication options without compromising quality.
4. Patient Satisfaction Scores: High patient satisfaction scores can indicate quality service and care, which can be a persuasive factor for PBMs and insurers when negotiating reimbursement rates. Regularly surveying patients and tracking these scores can provide valuable insights.
5. Clinical Outcomes: Metrics such as reduced hospital readmissions, improved chronic disease management, and other clinical outcomes can highlight the effectiveness of your pharmacy’s interventions. These outcomes are important to PBMs and insurers as they reflect the overall impact on patient health and cost savings.
6. Prescription Volume and Accuracy: Tracking the volume of prescriptions filled and the accuracy rate can demonstrate your pharmacy’s efficiency and reliability. High prescription volumes with low error rates can be a strong negotiating point.
7. Cost Management Metrics: Monitoring metrics such as inventory turnover, cost per prescription, and overall operational costs can help you identify areas for improvement and demonstrate financial efficiency to PBMs and insurers.

By focusing on these key performance metrics, your community pharmacy has the opportunity to see more favorable reimbursements and directly impact patient outcomes. These metrics not only showcase your pharmacy’s commitment to quality care and cost-effectiveness but also highlight your proactive role in improving patient outcomes.

• Utilize phone calls, text messages, or email reminders to prompt patients about upcoming doses or refills.
• Recommend or offer an app that tracks medication schedules, provides reminders, and allows for easy communication with the pharmacy.
• Provide pre-packaged medications in blister packs or use medication organizers to simplify complex regimens.
• Conduct regular Medication Therapy Management (MTM) sessions to review medications, address side effects, and assess adherence.
• Develop individualized medication management plans based on the patient’s specific needs and health conditions.

Encourage patients to discuss any issues or concerns about their medications to foster a supportive environment where patients feel comfortable asking questions. Use motivational interviewing techniques to explore and address barriers to adherence and enhance patient motivation. Examples of questions may include:

• “What is important to you?”
• “How do these behaviors conflict with your values?”
• “How would you go about making this change?”
• “What does change look like for you?”