Q&A: Pharmacy’s Evolving Relationship with Value-Based Care

In part 2 of his interview with Drug Topics, David Pope, PharmD, Chief Pharmacy Officer at XiFin, dove deeper into the idea of value-based care. He broke down how it differs from the fee-for-service model—what most pharmacies and their employees are used to—and its current perception within the industry. While it isn’t necessarily adopted on a universal scale, according to Pope, pharmacy has been providing value-based care for years.

“I think plans have always thought that pharmacy was an ideal place [for value-based care models] because of the number of times they see the patient. It's just always been difficult to scale on both sides, but now that's changing,” Pope told Drug Topics. “I believe that XiFin is right there, hand in hand, locked in arm with pharmacies and will continue to do so for years to come.”

This part of Drug Topics’ interview with Pope focused on the services pharmacies provide and the relationships Pope’s company XiFin has held strong throughout its time in the pharmaceutical industry.

David Pope, PharmD, Chief Pharmacy Officer at XiFin | image credit: XiFin

Stay tuned for more content from our interview with Pope covering multiple topics within value-based care, including where pharmacy benefit managers come into play and how pharmacists may be the best providers to facilitate this type of care.

Drug Topics: How does value-based care differ from the normal processes that pharmacies are used to when it comes to dispensing medications?

David Pope: The goal here clearly is: Let's make it as easy to be a pharmacist as possible. As I mentioned out of the gate with XiFin, that's our goal; to make it easy to be a clinical pharmacist providing care. Many times, this can be a challenge for value-based care. If we look at a patient walking in the door, they may be here for a fee-for-service opportunity. Maybe that's to fill a prescription, or maybe that's because they're saying, “I'm sick and I need your help. I need to be tested for flu, for strep, for COVID,” or beyond. As opposed to value-based care, which often isn't something that the pharmacist or the patient is going to bring up, many times they've shown up on a list inside the plan. [They’d] say, “Okay, well, patient David Pope is in need of a statin,” as an example to that, or [he is] not taking his medications appropriately. There can be a disconnect there of when I receive that information, and in what system I receive that notification, that David Pope needs something here, an alert, if you will. It's vital for us to be able to marry that experience together, so that when David Pope, the patient, comes in to fill a prescription at that pharmacy, that there’s also an alert that says there's another opportunity out here for value-based care.

READ MORE: Value-Based Care Models Can Help Pharmacies Improve Operations

Now, of course, that's just one pathway. There are other pathways that are out there in which pharmacy may receive a list of participants, and they may do outreach. They may use technology for that. They may just pick up the phone. Ultimately, we know that, not only that workflow, we try to make that as singular as possible, but the billing of that can be different. We may perform medical billing in some instances. We may bill using the traditional medical billing pathway, that's not an NCPDP pathway where you're billing a PBM. This is billing the medical benefit, and so we may need to do that. Of course, XiFin stands in the gap to do that for the majority of pharmacies today. But many times, with value-based care, there's just a unique relationship where it can be as simple as an Excel file or a CSV file that is completed and sent back to the plan for approval.

[It] happens in many different ways. There are some other pathways as well where we've seen, in some instances, for value-based care that they're paid off the result. So in other words, talk to the patient about the statin. We will pay you if we see the claim come across. [It’s] a lot of different avenues there. I would say that's a challenge for pharmacies, but also a great opportunity. Again, it does differ wildly on how they're reimbursed for it, but the pay is normally pretty good, and it is certainly something that pharmacies should be looking forward to.

Drug Topics: How has XiFin operated within value-based care models? Is it something that you have always explored or is value-based care a newly adopted idea for your company?

David Pope: Pharmacy has been doing this for many years, and so therefore, so has XiFin. I remember doing this with my previous organization that was ultimately acquired by OmniSYS, now XiFin. We were doing this 15-20 years ago. As well as, I think about other areas, such as the Asheville Project and those that went before my generation of pharmacists doing this as well. This certainly has evolved to some extent, but in many ways, it's just more scalable than it ever has been.

Pharmacies have traditionally not had an electronic health record before, and now they have an easy way to be able to document. They haven't been able to provide those alerts within workflow that they have before. Much of this is more scalable because of the tools and resources that pharmacies have. It's just easier to do it, honestly. So again, if this were cumbersome, if it were a list that were sent by the plan, and I had to disseminate that to all of my different locations, and then there was a disjointed approach to the workflow of the patient walking in the door versus value-based care, it's just not scalable. But now, those opportunities exist, and so we're excited to see the scale of this grow so quickly. I think plans have always thought that pharmacy was an ideal place because of the number of times they see the patient. It's just always been difficult to scale on both sides, but now that's changing.

Drug Topics: For independent pharmacies looking to improve their bottom line, why should they work with XiFin?

David Pope: First of all, we need to be aligned in mission. How do we see the marketplace today? Where do we see it going? The first thing I'm just most proud about, from a XiFin perspective, is the advocacy efforts that are done by XiFin alongside pharmacies today. Think about the work that we've done with the state and national associations, and this idea towards this ECAPS bill—that's the bill that would allow pharmacists to be able to bill and be reimbursed for services under Medicare Part B—has been unmatched. We've brought together physicians and other constituents to be able to lobby for that. I love what XiFin is doing.

Ultimately, beyond that, there's also a need to be able to make it easy to be a pharmacist and provide these services. We've been close to the pharmacist. Being a pharmacist myself, as well as our product management team and beyond, we've just been listening and saying, “Okay, what would it take for pharmacy to be able to change the model?” That's for both fee-for-service opportunities and for value-based care. And there are so many barriers that came up, and yet, one by one, [I’m] just proud of the XiFin team for being able to attack each of those areas…[finding] it's not a difficult paper-driven process, that reimbursement wouldn't be a mystery any longer, and that pharmacists and pharmacies would be able to submit a claim and tell their patient that, “Yes, you are covered for this service in my pharmacy.” Because of those things, I believe that XiFin is right there, hand in hand, locked in arm with pharmacies and will continue to do so for years to come.

READ MORE: Q&A: How Pharmacists Stand in the Gap for Value-Based Care

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