For pharmacists, when opportunity knocks, private payers are often on the other side of the door.
By donalee Moulton
To take advantage of the opportunities to have pharmacy services covered, pharmacists need to establish relationships, demonstrate value, and advocate for change.
“Frontline pharmacists are in the best position to do all of this. No one will tell the pharmacy story better than you will,” says Leanne MacFarlane, Senior Director of Business Development at MHCSI (Managed Health Care Services, Inc.) in Dartmouth, NS.
When opportunities with private payers are realized, the result is improved health for your patients and their employees. At MHCSI, for example, medication reviews have been covered in the last several years, and more recently additional pharmacy prescribing services are being covered. The reviews started as a pilot program that was so successful they became an inherent part of plans. Now comprehensive programs to help with smoking cessation and living with diabetes, among others, are also included as well as care plans to help patients reach their health care goals.
“Employers understand the connection between healthy employees and a healthy organization,” says MacFarlane. “They are not necessarily looking to cut costs; they are looking to enhance the value of their investment with better health for their employees. We need to show them how coverage of pharmacy services can do just that.”
Approximately two years ago, Green Shield Canada, located in Windsor, and the Ontario Pharmacists Association launched a pilot program called “Impact of Community Pharmacist Interventions in Hypertension Management on Patient Outcomes”. The initiative, which involved a randomized controlled trial with more than 150 patients and 38 community pharmacies across the province, examined the impact of a six-month, pharmacist-led hypertension management program on patient health outcomes.
“The pilot provided clear evidence that people who took part had better heart health, lower body mass index, increased compliance, and decreased drug costs at the end of the study,” says Sherry Peister, a pharmacist and Board Chair of Green Shield Canada.
Now the program is building on its success. As part of GSC’s Change4Life initiative, the Pharmacist Health Coaching – Cardiovascular Program is a new counselling service provided by Ontario and BC pharmacists that focuses on cardiovascular health and offers blood pressure and cholesterol management to patients. Pharmacists will be reimbursed for an initial assessment, which includes taking the patient’s history, identifying blood pressure and cholesterol goals and lifestyle changes, and up to three follow-up sessions.
“Green Shield has built this product into their plan. It’s the first of its kind,” says Peister.
Wellness and prevention are key targets for plan sponsors, she adds. “It’s about keeping employees healthier as opposed to simply paying for a medication.”
Pharmacists are key partners, but they need to work with plan sponsors to demonstrate the benefits of including pharmacy services in their plans. That requires advocacy and evidence. “Pharmacists need to understand the type of dialogue that resonates with private payers. They want to spend wisely and drive value,” stresses MacFarlane.
The conversation is an important one for pharmacists to initiate. The focus for the profession has often been on the public programs, but the reality is that 60 per cent of medications are paid by private payer plans. Pharmacists have a significant opportunity here to demonstrate benefits. But they need to be visible and they need to be heard.
“Pharmacists have been building relationships with private payer companies and employers for decades. It’s been a way to build business, but the opportunities today are greater than ever before,” says Peister.
So are expectations. Private payers are looking for proof that programs are producing positive outcomes. “You need to document results. This translates into something meaningful that you can discuss with the plan sponsor,” says MacFarlane.
As Canada’s most accessible healthcare professionals, pharmacists need to become more comfortable with their role as advocates. That role requires them to talk about payment for services, a conversation that is uncomfortable for many professionals. “Pharmacists need to recognize the importance of the services they provide and advocate with confidence,” says Peister.
Leaders in Pharmacy, including this independently written article, is supported by GenMed, a division of Pfizer Canada.
Our greatest asset as a profession advocating for change is our frontline pharmacists. These are the individuals who each and every day through their work connect with the public, with other health professionals, and with decision-makers.
By Billy Cheung
Region Director, Pharmacy & Strategic Initiatives, Pharmasave Ontario
Photo by Brandon Gray
Advocacy at this level, fortunately, is growing. It is, unfortunately, not growing fast enough.
In the last 10 years, advocacy efforts from the pharmacy profession have paid significant dividends. Medication reviews paid for by government, the legislative green light to prescribe medications, and the pharmacy as vaccination central are all advances that can be linked to advocacy. Without such efforts, we would not have witnessed the gains we take for granted today. And yet the number of frontline pharmacists engaged in advocacy remains small.
Two factors are at play. First, there is a misconception that advocacy only needs to occur when there is a crisis, when we need to rally the troops to address an imminent and serious issue. Nothing could be further from reality. Advocacy must be ongoing. It doesn’t just happen when you need something – nor should it.
Second, as pharmacists we often look to our professional associations to advocate on our behalf. Clearly, they play a key role. But pharmacists on the frontline have an equally vital role to play – and they are the only ones who can play it. In your day-to-day interactions with patients and customers, you have an opportunity to raise issues relevant to the profession openly and conversationally. Some of the people you speak with will be policy-makers, politicians, government leaders. Let them hear firsthand what is important to you as an important member of the health community.
I sometimes hear people say, “If the premier of your province were in front of you, what would you say?” The opportunity is much greater than a fortuitous meeting with a single politician. Ask yourself this: Why would you tell the premier anything different from what you would say to anyone else? The issues that affect us as pharmacists, that demand our attention, are issues we should be speaking with to everyone. We are all affected.
Advocacy on the frontlines must go beyond quick conversations at the pharmacy counter. As a profession, we would ask frontline pharmacists to take a leadership role. We recognize you are busy, that you have demanding jobs and active lives. Advocacy doesn’t have to be time-consuming nor expensive. Turning out a few times a year for the annual barbecue and other events hosted by your elected provincial government representative goes a long way to giving an expert voice and a human face to the issues.
Your engagement also speaks volumes to your colleagues. As pharmacists, we are not trained in advocacy or its importance. We learn to understand its essential role in our profession, and we must demonstrate this understanding through our own involvement and interest. Our professional associations can help by including government relations, public relations and advocacy education in their annual conferences. But they’re only successful if you show up, and bring a colleague with you.
Advocacy for many of us starts by being more fully engaged in our community. It expands from there to our commitment to speak with patients and others about the issues and our role in healthcare. It culminates with our presence on boards, in community round tables, and at local events. Advocacy pays off because we are part of the process.
Advocacy is an investment. Every issue and every decision will not go in the direction we’d like, but reaching our fullest potential as a profession only happens if our point of view is understood, respected, and weighed. For that, we must be at the table. When critical conversations occur, we must have the public face of pharmacy front and centre.
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