Is my Pharmacy ready to be in an eCare Plan?

Jonathan Jacobs
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Why should I be thinking about my store joining an eCare plan?

Today’s competitive environment for independent pharmacy dictates that you must have a niche opportunity or participate in programs that encourage traffic and keep your clients within your stores ecosystem.  The eCare plan has finally arrived after decades of promise with little practice due to a myriad of reasons. The clinically integrated network is now here!  

What does the term ‘clinically integrated network’ mean?
The term clinically integrated network is fairly-new to the pharmacy industry, so there is a chance you might not have heard of it. A clinically integrated network is a collection of health care providers that demonstrates value to the market by working together to facilitate the coordination of patient care across conditions, providers, settings, and time to improve patient care and decrease overall healthcare costs.

It is meaningful because a clinically integrated network of pharmacists can engage with payers to receive a share of the dollars that payers save in patient care costs as a result of the services provided by the clinically integrated network.  We’ve certainly all realized the value of performance based compensation in pharmacy today.  Your EQuIPP score and five-star rating has never been more important than today!

EQuIPP is an innovative performance information management platform that was designed to help pharmacists thrive in a value-based, quality-focused environment.  The passing of the HITECH Act in 2009 headed America’s effort to improve communication and ultimately continuity of care across the healthcare industry.

What is the value of being in a clinically integrated network?

By being part of a clinically integrated network, participating pharmacies can engage with each other to improve the quality of care offered to patients and to offer value to payers through enhanced services and lower costs. CPESN USA is clinically integrated which allows its networks of higher quality, lower cost pharmacies to engage with payers.  It would certainly pay to see what plans cover your stores’ geography and how many pharmacies are currently serving any particular ecare plan. If there isn’t enough plan adequacy you can solicit the sponsors of the eCare plan or network for your stores’ individual participation.

What is network adequacy?
The clinically integrated pharmacy network must have enough pharmacies in it to adequately cover the plan sponsor’s patients that needs the network’s services.  Connecting Health and Care for the Nation A Shared Nationwide Interoperability Roadmap the Office of the National Coordinator for Health Information Technology noted the following:

‘Providers should have the tools they need to support care transformation, i.e. using technology that supports the critical role of information sharing. This shift will open-up new possibilities for providers in how they engage with patients and interact with other care, support and service team members. For example person-centered planning, which includes individual goals and preferences, is increasingly recognized as an integral tool for supporting person-centered health, individual-provider partnerships, and coordinating care, particularly for individuals with chronic conditions and multiple co-morbidities. This has never been more relevant then now during this Coviid-19 Pandemic.  In a learning health system, person-centered plans will be seamlessly shared amongst a group of individuals in a way that allows all care, support and service team members to contribute to and maintain the person-centered plan. These interoperable plans will be used to support informed, shared decision-making between providers, patients and the full care support team.

Benefits of eCare Plans

Utilizing care goals and care actions in a pharmacy is important for providing a holistic, personalized level of care. In addition, pharmacies who submit eCare Plans to CPESN can be reimbursed for their value-based clinical services. Properly documenting and tracking all the steps taken to reach a patient’s health goals makes it easier to demonstrate the true value of the additional services provided. Each eCare Plan includes a payer section that acts as a means of claims submission for the pharmacy.  The benefits of implementing eCare Plans in a pharmacy setting are valuable for both the patient and the pharmacy. Expanding the use of eCare Plans will help to improve patient outcomes and reimburse independent pharmacists for practicing value-based care. An additional benefit is speeding up access to ePA’s Electronic Prior Authorizations. This is both a cost and labor time savings that busy pharmacies find immeasurable.

The Data-The cost

For healthcare data to move from one system to another and remain unchanged, it must be sent in a known, agreed upon format. This format, called C-CDA (Consolidated-Clinical Document Architecture) defines how electronic clinical documents should be organized at the data field level so the intended clinical purpose and meaning is preserved during an exchange. Examples of C-CDA documents s the History and Physical (H&P), Continuity of Care Document (CCD), Discharge Summary (if available), and Progress Notes. Each C-CDA document contains patient information for a specific use case. For example, the H&P contains background information that is relevant for a routine checkup or hospital admission including the patient’s problem list, allergies, current medications, family history, past procedures, etc.

The Pharmacist Component is where cost now complicates the issue tremendously!

A joint effort by multiple professional organizations, the PeCP’s development is led by the Pharmacy Health Information Technology Collaborative (Pharmacy HIT).  The PeCP is based on the HL7 standard which most Independent pharmacy software vendors already work within and was adapted for community pharmacy use, according to Shelly Spiro, executive director of Pharmacy HIT.  The PeCP allows every user to use his or her own system with data being input and received in different “languages.” Although pharmacists are already familiar with telecommunications for processing claims and prescriptions, innovation with the PeCP will allow pharmacists access to a complete medication list, its advocates said.  The PeCP represents an evolved workflow system that will increase productivity, Spiro said. “For the future, this is going to be the way our systems capture information,” she said. “You need to utilize your system to pull out what information is needed.”

On January 11, 2019, the PeCP launched an informational website that is supported by the Community Pharmacy Foundation. The website is intended to generate awareness for the PeCP with sections geared toward laboratories, payers, pharmacists, technology companies, and other supporters.

Care planning has become an essential part of the health care system, most health care interventions are ongoing and can last many years.  Treating chronic diseases have been linked to the majority of health care, morbidity, and mortality expenditures, according to the website. Chronic diseases are responsible for about 75% of the nation’s aggregate health care spending, as well as 96% of Medicare spending and 86% of Medicaid spending.

A result for pharmacists participating will be less administrative work and more time spent caring for patients, as well as decreased expenses, he said. “It’s so expensive right now to administer these programs, because we don’t have standards,” Trygstad said. “Payers are becoming providers; providers are becoming payers,” he said. “All these data streams need to come together.”
A pilot program proved the success of eCare plans across the board with the largest exception being the challenge of getting the software solutions in place at pharmacies.  Point of Care has plans in place for eCare program participation! To begin a discussion and to see a demo of our new PMS software RxInsight please click here.

We at Point of Care systems care

deeply regarding the public’s health throughout this pandemic and urge everyone to maintain social distancing and please wear a mask whenever possible.

Additional articles for review:

Star Ratings Critical to Medicare Prescription Drug Plans

The Psychobiological Elements of Patient Medication Adherence

Security tips for working from home

If you would like additional information on the ongoing work creating the eCare standard click here.

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