As American healthcare transitions toward paying for quality and value, rather than reimbursement based on the volume of individual transactions, many independent community pharmacists are at the forefront of this bipartisan change. Approximately 3,000 of these pharmacists, industry partners and students are meeting this week in the Washington, D.C., area. On the discussion agenda is their role in accelerating this transformation toward the dual aim of better health outcomes at lower overall cost.

Medicare, under both Democratic and Republican administrations, has driven these developments at the federal level. These quality initiatives span the entire health care system.

For instance, the Centers for Medicare & Medicaid Services (CMS) announced that, by 2018, half of all traditional Medicare payments (fee-for-service) will be tied to quality or value through alternative delivery methods such as Accountable Care Organizations (ACOs), in which some community pharmacists are taking part.

In the area of prescription drug benefits, CMS has already begun scoring Medicare drug plans based on the quality of care they achieve. These "star ratings" are available online. They can help shape the decisions of beneficiaries and caregivers as they select a drug plan, such as during the Oct. 15 - Dec. 7 open enrollment period. That's a powerful incentive for health plan sponsors to focus on quality of care.
Star ratings are based in part on how well a particular plan's patients take their medication as prescribed by a doctor (also called "medication adherence"). Pharmacy services are integral to medication adherence outcomes.

In particular, through medication synchronization, a patient's medications are aligned each month to be refilled on the same day. In addition to the convenience of fewer trips to the pharmacy, medication synchronization offers patients the opportunity for a more robust discussion with their pharmacist about their medication regimen and to identify any problems. This "appointment-based model" is gradually becoming the foundation of the way community pharmacy is practiced with a total patient focus, not individual prescription transactions focus.

Pharmacists are encouraged by a recent CMS announcement of a medication therapy management (MTM) demonstration program set for 2017 in 11 states. It encourages drug plans to support more in depth patient-pharmacist discussions about a Medicare beneficiary's prescription drug regimen.

These MTM exchanges more than pay for themselves. They bring to light medication problems that could lead to hospitalizations or worse. And they identify opportunities to utilize generic drugs.

As more focus is put on quality and value in today's health care system, community pharmacies are realizing they are going to be evaluated differently. New data will allow payers to know which pharmacies are taking care of patients in a way that minimizes avoidable costs. Independent community pharmacies are well positioned to be high performers in this regard. They are known for delivering personal care, usually on a first-name basis.

The most forward-thinking health plans are figuring out how to carve pharmacy back into their total benefit. Appropriate medication use and care management and coordination by pharmacists (who see patients more frequently than any other health professional) result in lower total health care costs. These shifts toward quality and value present tremendous opportunities and make for very exciting times.

Hoey is CEO of the National Community Pharmacists Association.