The New Year brings new goals, new perspective, new opportunities — and new challenges. Healthcare providers feel the pressure as they look to improve care quality, lower costs, and increase patient satisfaction while navigating unique economic and regulatory pressures. The shift towards value-based care, the increased financial responsibility of patients, and changing medication costs require providers to find new and innovative solutions in order to thrive.
In working with a variety of providers on solutions to address today’s biggest market pressures, we’ve identified four key areas in which practices should invest time and resources to be successful: inventory management, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, clinical research, and physician dispensing.
The critical success factor for a medical practice lies in gaining financial and operational control of its drug inventory. Even a single instance of a missed drug unit can cost thousands of dollars. Maintaining optimal inventory levels by utilizing an inventory management system with full visibility into every unit of medication will help plug potential profit leaks. By using an inventory management system, practices can see where cash flow is clogged and adjust. When practices can see their full inventory at once, they can make smart decisions based on patient scheduling, and ensure that the right product is in the right place at the right time. When evaluating inventory management models, practices should also consider options with payment verification components. This way, practices can follow drug doses from the time they are placed into inventory, through the billing cycle, until full payment is received.
The window for eligible clinicians to begin reporting data for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program opened in January. Eligible clinicians need to understand the program and make thoughtful changes in preparation for full participation.
For long-term success with MACRA and its Merit-based Incentive Payment System (MIPS) pathway, practices should evaluate their EHR system to ensure it’s compliant. Your practice should also carefully select Quality performance measures for reporting and review historical data. Identifying an in-house dedicated MIPS expert or external partner with historical success is a cost-effective investment. Having a knowledgeable and up-to-date resource can keep you informed of changing regulations and help you navigate complexities. Organizations should take advantage of MACRA’s extended transition period through 2018 to understand the program and make thoughtful practice changes in preparation for full participation.
In 2015, 1,375 community health centers provided care to 24.3 million patients, including 1 in 12 U.S. residents and nearly 1 in 6 Medicaid enrollees . Community practices are uniquely positioned to help patients access cutting-edge care through enrollment in clinical trials, but most lack the resources and access to make clinical trials available to the patients they serve. Practices should explore partnerships that can connect them to clinical trials and research opportunities.. These programs allow for a more streamlined approach to identifying, qualifying for, and enrolling in targeted clinical trials that offer groundbreaking treatment options. At the same time, they give manufacturers trusted access to additional qualified patient populations, outside of their traditional clinical trial partners, and streamlined enrollment for those patients.
Patient care and outcomes are optimized when prescriptions are as close to the physician as possible. In-office dispensing, which can include either a physician dispensing program or a retail pharmacy, enables providers to play a greater role in the pharmaceutical care of their patients. Practices looking to implement an in-office dispensing program need to be ready for the increased regulatory requirements to support the program and ensure they are properly structured to take on the additional workflow and responsibilities of dispensing.
Having an in-office dispensing program where clinical staff is part of the care team allows the practice to better manage the patient. If both the patient and the prescription are close to the provider, it has a positive impact on patient outcomes and provider measurement under a value-based care model. While the challenges that practices face this year and beyond are formidable, by creating smart solutions and strong partnerships, providers can come out on top. Focus on inventory management, MACRA, clinical research and physician dispensing – or find a partner who can help you address these four opportunities – and you, too, will soon find ways to expand offerings and remain financially viable while also achieving the ultimate goal of providing patients with the highest quality care.
About the Author
Barry Fortner, PhD, serves as SVP & President of Specialty Physician Services at AmerisourceBergen. Dr. Fortner has over 200 scientific publications and conference presentations ranging from early work in cognitive psychology, death and dying, and psychotherapy research to more recent work with health and patient reported outcomes, psychometrics, pharmacologic and health economics, quality improvement, and oncology therapeutics and supportive care. His scientific work also includes published statistical innovations regarding treatment induced deterioration, practice efficiency, opportunity costs, and clinical pathway compliance.