Design and effect of performance-based pharmacy payment models

BACKGROUND: Community pharmacy participation in performance-based payment models has increased in recent years. Despite this, there has been neither much research done to evaluate the effect of these models on health care quality and spending nor is there extensive literature on the design of these models. OBJECTIVES: To (a) describe the types of measures used in performance-based pharmacy payment models (PBPPMs); (b) describe the financial impact of PBPPMs on pharmacies; (3) explore pharmacy owners’ perceptions of PBPPMs; and (4) describe any practice changes made in response to PBPPMs. METHODS: This is a cross-sectional study that surveyed independent community pharmacy owners between November 2019 and January 2020. The survey included 45 items split into 5 sections that covered respondent characteristics and the 4 domain objectives. Descriptive statistics were used for quantitative responses, and free-text responses were assessed for themes. RESULTS: Of the 68 individuals who responded to the survey, 42 were community pharmacy owners who met the study eligibility criteria, and 30 responded to most survey items. Owners expressed frustration at the design of PBPPMs, with 90% stating that they did not feel that the actions necessary to meet or exceed performance standards were within their control, and 90% also reported a loss of revenue because of these models. In addition, large numbers of respondents felt that they did not have enough information on how performance measures were computed (76.7%) or how cut-points were determined (86.7%). Despite negative feelings, most owners reported implementing changes in service offerings as a result of these models. CONCLUSIONS: PBPPMs appear to be commonplace and put substantial financial burden on community pharmacies. Study results suggest that greater education by payers could improve pharmacist engagement, as could involvement of pharmacies in the design and maintenance of PBPPMs.