This is the second in a series of reports related to the valuable impact of more fully harnessing the tremendous clinical ability of pharmacies, as has been on full display during the COVID pandemic response.
A new report by NACDS and CapView Strategies examines the essential role that local pharmacies and pharmacists play in providing patient-centered services in their communities, and highlights how integrating pharmacies and pharmacists into value-based programs (VBPs) and alternative payment models (APMs) will help support the Biden Administration’s refreshed vision for the Center for Medicare and Medicaid Innovation (CMMI).
The report – “Accelerating the Center for Medicare and Medicaid Innovation’s Mission – Integrating Community Pharmacy Care into Value-Based Programs Amid COVID-19 Pandemic Recovery & Beyond” – is the second in a series of papers to be released by NACDS which center on the value of better leveraging the clinical expertise of pharmacies, as demonstrated during the COVID response, and which offer actionable blueprints and legislative solutions that will help the nation achieve better health for all.
Importantly, according to the new report, “the movement to value-based payment and care has been one of the most transformative changes in health care over the last decade,” and the Centers for Medicare and Medicaid Services (CMS) has accelerated the movement to value primarily through the CMMI – which has launched more than 50 VBPs and APMs since its establishment in 2010.
Now, as CMMI moves into its second decade, the Biden Administration is working to establish a sustainable path for the future that prioritizes the broader role of CMMI in health system transformation, and includes health equity as a central priority.
Of note, this new vision includes:
- driving accountable care through meaningful patient-provider relationships;
- advancing health equity through engaging providers and populations who have not previously participated in models;
- supporting innovations that close gaps in care;
- addressing affordability;
- and building partnerships with new providers and private sector payers to support transformation.
To achieve these goals, NACDS said in the report that “CMMI should consider incorporating into [its value-based and alternative payment] models those providers and settings that have the demonstrated ability to expand access and equity, improve quality and patient outcomes, foster meaningful patient-provider relationships, and reduce costs.”
Pharmacies and pharmacists – located within five miles of 90 percent of Americans – are extremely accessible, and are among those highly-trained providers who are well positioned for inclusion in CMMI models given their proven ability to meet these objectives. The value of pharmacy care has been demonstrated most recently through pharmacies’ remarkable efforts during the COVID pandemic response, however, pharmacies’ ability to meaningfully and positively benefit the health of the communities and patients they serve has been demonstrated long before the current pandemic.
Notably, throughout the COVID pandemic and thanks to pharmacy flexibilities granted under the Public Readiness and Emergency Preparedness Act (PREP Act) and other key federal actions, pharmacies have leveraged their accessibility and clinical expertise to help improve equitable access to COVID testing and vaccinations:
- As of November 9, through the Federal Retail Pharmacy Program (FRPP), pharmacies have provided more than 162.8 million COVID vaccination doses, and in recent weeks, more than 49 percent of people vaccinated through the program have been from a racial or ethnic minority group. (Pharmacies’ actual vaccination totals are even higher given that, in addition to shots provided through the FRPP, pharmacies also are providing shots through state programs).
- Within the FRPP, 45 percent of retail pharmacy sites were located in zip codes with high social vulnerability scores.
- Under a public-private partnership with the Department of Health and Human Services (HHS), 70 percent of COVID testing sites were located in communities with moderate to high-social vulnerability – further demonstrating the role that pharmacies can play in increasing access and reaching vulnerable communities. As of March 8, more than 6,000 live testing sites were established under this partnership with over 9.8 million samples processed. More recently, in early October, planned program expansion was announced to include 20,000 pharmacies.
“These new authorities and flexibilities that have been extended to pharmacists, as well as the longstanding capabilities pharmacists have demonstrated during the public health emergency, can be built upon, and leveraged in the testing of a pharmacy-focused VBP model,” NACDS noted in the report.
Beyond providing COVID vaccinations and testing, pharmacies also continued to provide needed preventive services – including screenings and vaccinations, chronic disease management (especially for diabetes, cardiovascular disease and more), and medication optimization services such as medication adherence interventions – which are all central to maximize the benefit of CMMI’s largest models.
Despite their extensive clinical training, medication expertise, accessibility, and integration in the communities they serve, however, pharmacists are currently unable to participate directly in CMMI’s models.
NACDS, therefore, included in its new report the following actionable recommendations for CMMI, so that the Biden Administration may further its goals to drive value for Medicare beneficiaries, the Medicare program – and more broadly improve healthcare quality and value – by including pharmacy-based care in current and future VBPs and APMs:
- “Recommendation # 1 – Include pharmacists and pharmacies as eligible providers and/or suppliers in existing and future VBPs and APMs.
- “Recommendation # 2 – Allow pharmacies to be directly paid and/or incentivized for providing care to beneficiaries that improves quality of care, health outcomes, and reduces total cost of care.
- “Recommendation # 3 – Develop and implement meaningful measures, including standardized pharmacy-level quality metrics, across all VBPs and APMs, payers and programs.
- “Recommendation # 4 – Support advancements in health information technology, interoperability and other tools that support coordination across providers, including the bidirectional integration of pharmacy data into broader systems.
- “Recommendation # 5 – Test a pharmacy value-based program to increase access to evidence-based community pharmacy care for Medicare beneficiaries.”
In October, NACDS released its first report in the series – which focused on pharmacies’ success before and during the COVID pandemic in confronting health inequities and disparities, and issued recommendations for further progress in this critical area.
