Strategies for Success: How to Navigate the Evolving Health Care Landscape and Unlock Alternate Revenue Streams

As the pharmacy industry continues to rapidly evolve, inevitably there will be many challenges to overcome. Among the biggest difficulties pharmacists face today are reimbursement pressures, a lack of standardization, fragmented data, and the struggle to deliver the best quality of care while simultaneously increasing the volume of care.

At the Total Pharmacy Solutions Summit Summer 2024, held virtually on July 13, 2024, Emily Endres, BSPS, vice president of pharmacy at Innovaccer, hosted a session titled “Strategies for Pharmacy Success: Navigating the Evolving Health Care Landscape and Unlocking Alternate Revenue Streams.” Endres discussed the evolution of health care, as well as the knowledge and skills that pharmacy professionals need to adapt to the changing environment.

Emily Endres, BSPS, is the vice president of pharmacy at Innovaccer. | image credit: Bonsales / stock.adobe.com

“You can’t understand where you’re going if you don’t know where you have been,” Endres said during her presentation. “And what history tells us is that change in this industry is continuous, it’s expected, and it’s necessary. On the other side of that change will come some growth. What I think is really impactful about the history of our profession and this industry is that if you think about it, in all of those eras, quality and care have been at the foundation of all of those changes.”

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Read on for some key takeaways from Endres’ session:

• Pharmacy practice has continuously changed in the US since its inception, from the US Pharmacopeia being created in 1820 and revenue being diversified in the “soda fountain era” of 1920 through 1949, to pharmacists increasingly being recognized as clinicians from 1980 to 2009 and the expansion of clinical services from 2010 to the present.
• Today, there are numerous gaps that have been created due to the shifts in health care over time. These include pharmacy reimbursement pressures, operational challenges, rising cost pressures, and fragmented data.
• Centers for Medicare & Medicaid Services (CMS) created the star ratings program in 2006 to shift the industry toward quality and value-based care models.
• The star rating program has 3 phases: keeping members healthy, keeping members happy, and keeping each individual member healthy. Keeping each individual member healthy, which is referred to as health equity, is now CMS’ biggest focus.
• Value-based care promotes health equity by aligning providers on patient goals, decreasing overall health care costs, managing chronic diseases more effectively, improving patient behavior patterns, and decreasing mortality and morbidity.
• Pharmacists need to decide whether to maintain or expand services in 2024. Maintaining means continuing to dispense medications for point-of-sale reimbursement. Embracing change means continuing to dispense medications while also utilizing data to optimize workflow, engage with clinical services opportunities, and leverage core competencies to engage with payer programs.
• To be successful in the changing landscape, pharmacists need to create an actionable strategy that includes payer programs and patient engagement, using resources for performance improvement.
• Pharmacists also need to BUILD for their community: Be bold, understand goals, influence patients, learn from history, and do what works.

Read more articles from the Total Pharmacy October 2024 issue and visit drugtopics.com/TPSSSummer2024 to watch all the Total Pharmacy Solutions Summit sessions on demand.

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