Performance-based pharmacy payment models: the case for change
John Jackson A C and Ben Urick B
+ Author Affiliations
- Author Affiliations
A Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic. 3052, Australia.
B UNC Eshelman School of Pharmacy, 2400 Kerr Hall, 301 Pharmacy Lane, University of North Carolina at Chapel Hill, NC 27599-7475, USA. Email: benurick@email.unc.edu
C Corresponding author. Email: john.jackson@monash.edu
Australian Health Review 43(5) 502-507 https://doi.org/10.1071/AH18201
Submitted: 30 September 2018 Accepted: 3 April 2019 Published: 11 September 2019
Abstract
In response to rising healthcare costs, healthcare payers across the globe have been experimenting with performance-based payment models that link payments to providers with the quality of care that they provide. Community pharmacy in Australia has yet to be significantly affected by these changes. Initial steps have been taken to fund quality-linked interventions by pharmacists, such as the provision of medicines in dose administration aids, but funding for dispensing prescriptions remains solely based on a fee-for-service model. At the foundation of any performance-based payment model are measures that, in aggregate, reflect the quality of care that is provided. Patient adherence to prescription regimens can be correlated with the counselling provided by pharmacists and, as such, can serve as the measure on which a performance-based payment model for dispensing can be constructed. Experience in the US suggests per-prescription payments to a pharmacy can be increased or decreased by a small, yet meaningful, amount based on a measure of the level of adherence of patients of the pharmacy. The current dispensing payment model in the Australian Pharmaceutical Benefits Scheme may be able to be modified in a similar manner to support provision by pharmacists of improved quality of care.
What is known about the topic? Dispensing in community pharmacy in Australia is currently remunerated on a fee-for-service basis that carries no incentive to deliver an enhanced performance that could lead to improved quality of care.
What does this paper add? Several countries have introduced alternative payment models that link the level of funding to the quality of services provided by healthcare practitioners, and potentially to patient outcomes. Counselling is an integral aspect of pharmacists’ dispensing and, based on the principle that counselling improves adherence, which improves outcomes, remuneration paid to a pharmacy for dispensing could be adjusted in relation to the level of adherence demonstrated by patients of the pharmacy.
What are the implications for practitioners? Pharmacists would be incentivised through quality-linked dispensing remuneration to provide enhanced counselling and other inputs that lead to improved patient outcomes and health system benefits.
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