Why Quality Matters MORE in 2024

Podcast Host Nick Dorich, PharmD, PQS Associate Director of Pharmacy Accounts, chats with Emily Endres, VP of Client Services at PQS about why pharmacy and healthcare quality will matter more in 2024.

Endres talks briefly about CMS legislation in 2024 and how that affects quality care and why that still matters for pharmacies. There is also discussion about what pharmacy teams should prioritize in relation to medication, adherence and and engagement.

Chapters

• 1:43 Introduction
• 5:33 CMS Legislative Changes
• 9:41 Quality Measures Matter
• 14:19 What Pharmacy Teams Can Prioritize in 2024
• 16:28 Actions for Health Plans in 2024
• 19:47 Closing

Transcript

00:00:01:08 - 00:00:28:16

Emily Endres

In the vein also of kind of this member patient advocacy, We see this notion of creating a high quality member experience that that's continuing to be the focus, right? This drive for quality over quantity just continues to gain stronger legs and moves us all forward, which I think is really exciting. But what that definitely means is that quality does not go anywhere in 2024.

00:00:28:18 - 00:00:51:13

Emily Endres

And I would argue it actually is an opportunity to double down on quality and how you deliver quality care to the patients that you're serving. And there's a really unique way to think about what quality looks like in 24, but more importantly is how you articulate the value of quality that you're providing to the patients that you serve starting in 2024 and moving forward.

00:00:51:15 - 00:01:16:16

Intro

Welcome to the Pharmacy Quality Solutions Quality Corner show where quality measurement leads to better patient outcomes. This show will be your go to source for all things related to quality improvement and medication use and health care. We will hit on trending health topics as they relate to performance measurements and find common ground for payers and practitioners. We will discuss how the platform can help you with your performance goals.

00:01:16:18 - 00:01:38:05

Intro

We will also make sure to keep you up to date on pharmacy quality news. Please note that the topics discussed are based on the information available at the date and time of reporting. Information or guidelines are updated periodically and we will always recommend that our listeners research and review any guidelines that are newly published. Buckle up and put your thinking cap on.

00:01:38:07 - 00:01:53:11

Intro

The Quality Corner show starts now.

00:01:53:13 - 00:02:13:22

Nick Dorich

Hello Quality Corner Show listeners. Welcome to the PQS podcast, where we focus on medication use, quality improvement and how we can utilize pharmacists to improve patient health outcomes. I'm your host, Nick Dorich, For today's episode, we want to look a little bit ahead to the future, but not that far ahead. We're only look into 2024, but at the time of recording, we're about a month away.

00:02:13:22 - 00:02:30:24

Nick

By the time you listen to this episode will be probably just a few weeks. So make sure folks get your holiday shopping if that's applicable for you. Make sure to get a present for mom. That's a must do. Don't forget that. But we're going to jump into today's episode and introduce our guests. And it is a returning guest to the Quality Corner show.

00:02:31:01 - 00:02:39:10

Nick

And that guest is Emily Endres, who is our vice president client services here at PQS. So, Emily, welcome back to the show and how are you today?

00:02:39:12 - 00:02:55:21

Emily Endres

Hey, thank you for having me, Nick. It is great to be back, especially now. You've had quite a lineup of guests here in the last few weeks, so I am excited to be back. I'm honored. I'm really looking forward to this discussion this morning. So thanks for having me.

00:02:55:23 - 00:03:18:14

Nick

Perfect. Well, Emily, before we jump into the conversation about 2024 and specifically, we're going to talk about health plan, pharmacy engagement, relationships for 2024. There are some big changes or some big events, things that are going to be happening that in the industry that'll cause some shift. But before we get into that, we need a quick, quick rundown who you are so that our guests know who you are and kind of what is your background.

00:03:18:14 - 00:03:25:10

Nick

So do you mind giving us just a quick 30-second, You know, what is your background and what is it that you do here and the US?

00:03:25:12 - 00:03:53:06

Emily Endres

Yeah, absolutely. So I am the Vice President of client Services here and my role within this organization is to find ways and opportunities to bring health plans and PBMs together with pharmacy providers, to find meaningful and valuable ways to partner and collaborate together and using quality measurement as the foundation for those collaborations. That's what I do here for our team and enjoy it thoroughly.

00:03:53:06 - 00:04:19:20

Emily Endres

Getting to kind of sit on both sides of that fence and be a convener. And that's what what drives my passion and kind of everyday work here at Peaks, I spent ten years in the community pharmacy space behind the counter and beyond the counter, all things operations related. Then I transition to taking a very deep dive into managed care and third party contracting as a product owner.

00:04:19:20 - 00:04:42:15

Emily Endres

So I have been in this space for a very long time, spent my entire career in the space of Pharmacy and Health care And you know, to kind of looking ahead, it has been incredible to understand the amount of change that we've seen here within pharmacy over the last decade. And it's of no surprise that it just continues to evolve very quickly year over year.

So.

00:04:43:23 - 00:04:58:15

Nick

Yeah, absolutely. The only constant, Emily, is change. And we're going to be talking about those changes in 2024 in just a moment. But we're going to pause very quickly to hear a quick message in the breakdown from our teammates at PQS.

00:04:58:17 - 00:05:23:05

Breakdown

Now it's time for the breakdown and Quality Corner Show those missing as three main topic questions. Our guests will have a chance to respond and there will be some discussion to summarize the key points this process will repeat for the second and third questions, which will wrap up the primary contents of this recording. After that, it's going to end on a closing summary, usually containing a bonus question.

00:05:23:07 - 00:05:29:24

Breakdown

Now that we have the start of the process, let's jump into the questions.

00:05:30:01 - 00:05:52:22

Nick

All right, Emily, we are back and we're ready to jump into our conversation for today. And we're talking about 2024 calendar year, 2024, January one through December 31st. It's going to be a different experience for health plans and pharmacies, really from a number of reasons. So let's just kind of take this from the high level and that 30,000 foot level and then drill down a little bit.

00:05:52:24 - 00:06:09:13

Nick

What should we as the community pharmacy, as the pharmacies engaging with health plan opportunities and providing patient care, What should we be aware of from a CMS perspective? And then also perhaps other legislative changes that can impact the pharmacy health plan payor relationship?

00:06:09:15 - 00:06:32:02

Emily Endres

Yeah, so I think that's a great place to start. Nick, And taking kind of that macro view of the landscape and those changes that are coming down the pike here in just a couple of weeks. Right. So certainly in my comments, I'm not a representative of CMS by any stretch or nature here, but just some observation based upon final rules, regulations and legislative changes that have certainly been enacted.

00:06:32:04 - 00:07:03:04

Emily Endres

I think there are a few things that are really key and pillar moving into 2024, and those two things are transparency and member advocacy. I think that CMS has done a great job at making some updates within the legislation that allows for greater transparency and certainly allow for the voice of the member, which is your patient as a pharmacy or the consumer of health care to be heard and to have a greater kind of voice within their own health care journey.

00:07:03:04 - 00:07:30:03

Emily Endres

So on the transparency piece, we see kind of this and I'm using air quotes that you can't see this end of the air, which is really just a translation of point of sale pricing. Transparency for pharmacy reimbursement doesn't necessarily change the economics of pharmacy reimbursement, but just how that information is relayed and delivered at the point of sale, which also speaks to the member kind of advocacy area of it too, right?

00:07:30:03 - 00:08:05:00

Emily Endres

So that patients understand or have a better understanding of what their overall out-of-pocket costs are at the time versus any additional adjustments that potentially could be made. And so in the main, also it's kind of this member or patient advocacy. We see this notion of creating a high quality member experience that's continuing to be the focus, right? This drive for quality over quantity just continues to gain stronger legs and moves us all forward, which I think is really exciting.

00:08:05:02 - 00:08:32:18

Emily Endres

But what that definitely means is that quality does not go anywhere in 2024. I would argue it actually is an opportunity to double down on quality in how you deliver quality care to the patients that you're serving. And there's a really unique way to think about what quality looks like in 24, but more importantly is how you articulate the value of quality that you're providing to the patients that you serve starting in 2024 and moving forward.

00:08:32:20 - 00:08:58:03

Nick

So Emily, Quality can be discovered and talked about, evaluated in a number of different ways. And part of the quality spectrum is some of the more subjective experience, right? So you talked about the patient or member experience. There's a lot of opportunities and as we've talked with pharmacies, right, because some of these changes we've known or they were communicated this past year or even in some cases the year before, but they're just finally being implemented, right.

00:08:58:05 - 00:09:20:16

Nick

January one or at some point here in the year. So it becomes a part there where as we've talked with pharmacies as well, hey, what else can pharmacies do to show that they are a health care provider that can help with these patient patient care opportunities? And some of it is going to be things that are very strategic as it relates to screenings and health tests, things of that nature.

00:09:20:16 - 00:09:41:11

Nick

Some of it is going to be more patient survey opportunities or things like that, which some folks may not necessarily think was part of their pharmacist training, but it's a part of that whole patient experience. And Emily, you and I both know from working in a pharmacy that we don't treat the disease, we treat the whole patient. So I think this actually does come around to a change that is quite beneficial for pharmacy.

00:09:41:17 - 00:09:59:00

Nick

But I want to go back to your point and actually double down on this a little bit about quality. And does it matter for pharmacies in 2024? Right. We know with the change with are there some folks who have said, well, hey, quality measures are not going to matter for pharmacies? Emily Is that true?

00:09:59:02 - 00:10:28:02

Emily Endres

Nick That is false. Absolutely. Quality. 100% still matters in 2024. You know, I was chatting with the pharmacy not too long ago and I feel like they said this best. We as pharmacy and pharmacists have always been in the business of ensuring our patients get the right medication at the right time every time. That's adherence. Right? We've been doing that for ever.

00:10:28:06 - 00:10:48:03

Emily Endres

We just are calling it something maybe a little bit different now, and we're holding ourselves accountable to that in a different way. And that really started back in 2015. I think you can think about some of the first managed care contracts that hit the market where accountability to adherence took on a whole different meaning. Right. But we've been doing that.

00:10:48:03 - 00:11:19:00

Emily Endres

That's core to our business and that won't change. That should continue to be a focus and thinking about entering into relationships where pharmacies being held accountable in some way, shape or form to that, but also having the opportunity to diversify their revenue stream based upon the pharmacy's ability to exceed in that area doing something that you've been doing for such a long time takes on a little bit of a different meaning starting in 2024 and moving forward.

00:11:19:02 - 00:11:42:23

Emily Endres

And now I would just say and suggest here that CMS really is the largest payer in the US marketplace here. They, like I mentioned, continue to focus on quality over quantity. And what we've seen at a macro level is this alignment of incentives and that is still very much in play in 2024. And it is a bold statement in Medicare with the star ratings, right?

00:11:42:23 - 00:12:10:23

Emily Endres

It's very clear how incentives are aligned from a health plan to a member patient and then to providers, all provider types, including pharmacy, where we have an opportunity to make a huge impact. We see Medicaid moving in this direction, right? So CMS published the Universal Foundation set of measures. We saw legislation come out that is requiring all Medicaid health plans to submit their quality reporting to CMS.

00:12:11:00 - 00:12:45:07

Emily Endres

Right. CMS is not going to back down on the use of quality measures and continuing to provide quality care to its member beneficiaries or your patients. Right. You know, really, again, those benefits of improving patient health outcomes and measuring that improvement through the use of quality measures, that's not going away. Just the mechanics on how that story is being told or the opportunity to, again, as a pharmacy, understand how you can diversify your revenue stream for really engaging with those opportunities.

00:12:45:07 - 00:12:47:11

Emily Endres

That's what changes in 24.

00:12:47:13 - 00:13:09:13

Nick

Yeah. Before we continue, Emily, I'll I'll note one item or question that we hear from pharmacies and in the landscape from the last couple of years is that, you know, the focus on, you know, just Medicare is something that is sometimes troubling, right? Because pharmacies want to provide care and some of these opportunities to patients across the spectrum, not just the Medicare patients.

00:13:09:13 - 00:13:36:14

Nick

And also there's an aspect of this where you know, a patient doesn't just doesn't does not just start as a medicare patient. Right. There is a lead up, you know, for them, you know, through their many years of life until they hit age 65. So the more pharmacies can provide or offer these services to patients earlier in the life cycle or with prior types of insurance coverage as well, the more patients as consumers are used to receiving this type of service from their pharmacy, from their pharmacist.

00:13:36:19 - 00:13:52:24

Nick

And so, you know that that's where we still have some work in progress to go in that area. But I think as you spoke to it, we're seeing more opportunities in Medicaid, which is expansive but not fully expansive, where, you know, and we're also seeing that with some commercial payers as well, that there's more interest in taking on new opportunities.

00:13:52:24 - 00:14:20:07

Nick

So focus, folks, is still really going to be that Medicare population around quality measures and adherence. But we are seeing expanded opportunity as at the same time. Now, Emily, before I want to try to wrap us up a little bit here. So these two questions, they may be a little bit kind of shorter or more brief as we head into 2024 or if the pharmacy team is listening in this episode at the beginning of 2024, what are your words of wisdom?

00:14:20:07 - 00:14:30:17

Nick

You know, what should they prioritize? What should they consider around quality, quality improvement, medication, adherence, and engagement with health plans? In 2024?

00:14:30:19 - 00:15:06:07

Emily

You said it, it's “ENGAGE”. I'll keep this simple. You have to engage as a pharmacy. You have this spotlight here and now, right? Pharmacy helped the world get through the pandemic, and it provided this ginormous spotlight on the great levels of patient care that pharmacies can serve and that they are serving. Right. Engage, when you have an opportunity to think about or to really involve yourself in a program where maybe it's adherence based and maybe your pharmacy that has blood pressure opportunities for us through the EQUIPP dashboard or even see opportunities.

00:15:06:09 - 00:15:30:09

Emily Endres

You know, I tell my kids this all the time. I'm not equating our listeners to my kids, but all my kids all the time. Actions speak louder than words. Words are important and words are very powerful. However, actions engaging, showing that you're engaging, completing opportunities, interventions, whether it's through equip or any platform that you have access to, you have to engage.

00:15:30:11 - 00:16:09:09

Emily Endres

We have a shortage of providers. That's no new news to any of our listeners here, right? And so that just opens up additional opportunities for pharmacies to continue to think about expanding their scope, not just for pharmacists, but for pharmacy technicians and other credentialed members of the pharmacy care team. But now is literally the time. So taking that back, thinking about how you can engage with opportunities that are currently present within, you know, the patients that you're serving and thinking about how you incorporate those different clinical care items into your workflow in a sustainable way.

00:16:09:11 - 00:16:12:09

Emily Endres

That's where I would focus my efforts if I was pharmacy.

00:16:12:11 - 00:16:28:04

Nick

Emily As you led off that answer, it just made me think one of my favorite leaders, and it's a fictional person, but one of my favorite leaders in my lifetime that I've known and loved is Jean-Luc Picard from Star Trek The Star Trek The Next Generation, and his catchphrase just engaged as the ship goes off to warp speed.

00:16:28:04 - 00:16:47:13

Nick

Folks, that's what we need to do. I'm just I'm just going to send that as a meme to every pharmacy that I talk to about what we need to do to make these programs and work successful in 2024. But before we go, Emily, let's flip that question real quick. What's the call to action or words of wisdom for health plans and how they can and should engage with pharmacies in 2024?

00:16:47:15 - 00:17:20:22

Emily Endres

Absolutely. So for health plans, I would suggest start early, allow pharmacies the opportunity to manage the patient and manage a whole population. Right. We just talked about it. Appearance is on time every time. That doesn't just happen one time, right? That's a succession of interventions and touch points throughout the course of the year. So start early, provide as much visibility as you can for pharmacies to be able to interact effectively with their members or patients, rather, throughout the course of the year.

00:17:21:00 - 00:17:50:00

Emily Endres

Program design is key. Apply the KISS method, keep it simple sign and right. Keep expectations reasonable and worthwhile for all of the parties involved. You have to keep in mind we're asking for a change, right? And we're not asking just for a change for pharmacies. We're also asking for a change in patient behavior. So we think about the really exciting programs that are in the marketplace right now around pharmacies, collecting blood pressure readings and see readings as well.

00:17:50:06 - 00:18:12:21

Emily Endres

You know, that's a change for a patient to think about. Oh, hey, I can go into my pharmacy and absolutely have my A1c checked and then the pharmacy is going to provide further care, etc.. So it's a change for the pharmacy and it's a change for the patient. So have, I guess, patients with that process. It's not a one and done, but it's kind of a crawl, walk and run scenario.

And so just keeping that in mind.

00:18:15:03 - 00:18:38:23

Nick

Yeah, there's definitely a scaling up that needs to happen because while pharmacies certainly can provide these services and work with patients and that sort of way, pharmacies are also busy. And while pharmacies I'm sure would love to have patients lining up to get blood pressures, blood pressure screenings or hemoglobin A1C screenings, all these other things, I'm sure they don't want that happening all just at once, because then it's going to be difficult to get much of the normal day to day work done.

00:18:39:03 - 00:18:57:06

Nick

So, yeah, there does need to be a scaling up that needs to be considered here. But Emily, great conversation. I know 2024 it's going to have its changes, it's going to have its challenges and that can make folks feel uneasy or uncertain. Change always does that, but I'm feeling pretty positive about what's going to be coming in 2024.

00:18:57:08 - 00:18:59:09

Nick

What are your general feelings? What's the gut check?

00:18:59:12 - 00:19:24:09

Emily Endres

Oh, lots of positivity. And I mean that sincerely and from a genuine space. If you know me personally, you know, positivity is just kind of part of my quilts. But I'm being very, very sincere about that. Right. There's a lot of opportunity. There's a lot of potential for pharmacies to create and continue to carve a new and different pathway that helps to diversify.

00:19:24:09 - 00:19:48:16

Emily Endres

The revenue stream gives you a different lever, honestly, of negotiation, right? A different way of differentiating your services, your patient care compared to others, which I think is really important within our marketplace. So there is no shortage of opportunity to be able to tell that story in 2024 is the pharmacy. It's very exciting.

00:19:48:18 - 00:20:07:19

Nick

Yeah, I think so, too. All right, Emily, before we wrap up, we usually end ourselves with some on rapid fire questions, or we're going to hit you just with a couple for the sake of time here for today. But first question for you. What makes you most appreciative to be working with and supporting the pharmacy profession?

00:20:07:21 - 00:20:29:05

Emily Endres

Oh, okay. That's a great question and that's an easy one for me to answer, actually. So as I mentioned earlier, I have only worked really in the space of pharmacy as it relates to health care and that I started at a very early age where I had the opportunity to work behind the counter as a technician. That's how I started.

00:20:29:05 - 00:20:57:14

Emily Endres

And it was so clear at that point in time that the pharmacy patient relationship is special and unique. Again, having worked in other kind of provider types or settings, but certainly I'm a consumer of health care. I've been a caregiver for a few different family members, so I have seen different interactions very closely. But it is not the same as the pharmacy patient interaction.

00:20:57:14 - 00:21:23:01

Emily Endres

And I miss those days, to be honest with you. Some of the best conversations ever happened behind the counter. It's so unique and it again, it's very empathetic and I would suggest intimate, right? And however we can figure out how to continue to display that and make that a part of the patient's really health care journey. That's what I'm here for.

00:21:23:03 - 00:21:27:11

Emily Endres

That's what I'm most appreciative about. Thank you to all of those pharmacies out there.

00:21:27:13 - 00:21:43:02

Nick

All right, Emily, next question. I'm curious, best your answer on this one, if you could have a superhero working with you either in your work today or in your prior work experience in a pharmacy, who would that superhero be?

00:21:43:04 - 00:22:14:05

Emily Endres

Oh, Nick, okay, I'm going to lean on you for some help in this answer. I, I don't know the name, so you're going to have to help me with this. But if I can have a superhero that's attached to my head that has, like, multiple arms working behind the pharmacy, right? There's so many things happening. If I could have just had, like three more arms or hands to do different things, I find that in my current experience today, what superhero would that be?

00:22:14:05 - 00:22:16:04

Emily Endres

There's got to be a Marvel, somebody.

00:22:16:04 - 00:22:37:12

Nick

That, yeah, there are multiple, multiple with multiple arms. But I think I may go for a choice of Mr. Fantastic from the Fantastic four. So, you know, he can, he can stretch out and then at least at the very least, he was acted by John Krasinski of the Office Fame and one of the more recent movies. Whether or not he gets the term long that that that role long term, we'll see.

00:22:37:17 - 00:22:44:23

Nick

But I would go Mr. Fantastic. He's also a really smart, like, super genius level scientist. So that's probably also helpful in a pharmacy.

00:22:45:00 - 00:22:48:09

Emily Endres

That's absolutely right. Yeah. I want to be that guy.

00:22:48:11 - 00:23:13:24

Nick

Excellent. All right, well, add Mr. Fantastic to the pharmacy, working with Emily. Emily, we appreciate you. Appreciate having you on the show today, providing insight and information. If folks have questions or they want to find more information or opportunities about how they can engage with us at us around these opportunities in 2024, who where should they contact and any general, you know, places that you would recommend for them to find more information?

00:23:14:01 - 00:23:36:05

Emily Endres

Yeah, absolutely. So you can always reach out to support pharmacy quality econ and we're here and ready and willing to take any questions that you may have. And and certainly, you know, reach out to anyone here on the team. We're happy to have a conversation around the upcoming changes. And Nick, thanks for having me today. It's been a fun conversation.

00:23:36:07 - 00:23:37:12

Emily Endres

I appreciate it.

00:23:37:14 - 00:23:53:20

Nick

I'll double down on the comment, Emily, to just hey, if you have questions, come talk to somebody at the peak US team. As you can see from here, from this conversation today, Emily and I love to talk and we would love to talk to you, so please contact us. But listeners for that, that actually does wrap us up for today's episode.

00:23:53:20 - 00:24:03:19

Nick

So we thank you for joining and another episode of The Quality Corner Show. We hope you listen to our next episode. Before we go, we have one final message from the peak team.

00:24:03:21 - 00:24:25:09

Outro

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00:24:25:11 - 00:24:47:16

Outro

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