It’s no secret that, for hospitals, one of the Affordable Care Act’s most far-reaching legacies is the impact that Value-Based Care has on the payments they receive. For many health systems, the lower their Value-Based Care scores, the lower the payments they receive from treating Medicare and Medicaid patients.
What isn’t as commonly considered — particularly among entities with 340B programs — is the positive impact their 340B programs can have on their Value-Based Care scores. Below is an overview of techniques ProxsysRx uses in combining proactive prescription support from health systems’ retail pharmacies with strategic use of 340B program pricing.
Using 340B programs to reduce readmissions
According several online sources, including a 2021 peer-reviewed research article, up to 70% of all preventable readmissions are due to medication non-compliance. At the same time, among lower income patients — the demographic often served by DSH hospitals (Disproportionate Share Hospitals) with 340B programs — the number one reason behind prescription non-compliance is simple lack of ability to pay.
Among that more vulnerable patient population, a $100 prescription can be absolutely cost-prohibitive. And so, without some kind of help from their health systems, those patients simply go without.
How ProxsysRx’s 340B programs help prevent that problem
ProxsysRx manages and/or owns outpatient pharmacies on health system campuses nationwide. At a number of those hospitals with 340B programs, our pharmacists support its providers by helping them determine the best available 340B-eligible medications for patients in need.
Within virtually every medication class, there are Good, Better and Best available medications. When the best available medications aren’t covered by hospitals’ 340B programs, ProxsysRx’s pharmacists can ask our 340B team to access our database of National Drug Codes (NDCs, which are identifier codes for drugs used by the FDA) for the best available medications eligible for 340B savings.
That said, there are still many instances where even 340B-eligible pricing is cost-prohibitive for patients. In cases like that, our pharmacies have a tremendous amount of experience and expertise in accessing charitable-care programs — enabling patients in need to get their medications at even lower prices, or at no charge altogether.
Why using 340B programs to give patients free medication makes sense
We’ve already discussed the impact that prescription non-compliance can have on Value-Based Care scores — through increased readmissions. The fact is that patients who can’t afford low-cost prescriptions available through 340B programs certainly can’t afford the cost of return hospital visits. Which generally means that, in all likelihood, their hospitals will not be compensated for treating their return visits. In short, absorbing the costs of those patients’ prescriptions is significantly easier than absorbing the costs of treating them upon readmission.
Supporting 340B programs without ProxsysRx-managed pharmacies
For hospitals whose 340B programs we manage, but where we don’t own or manage on-campus retail pharmacies, our 340B team is still available to help guide clinical-practice decisions. We’re always there to help physicians select the best available medications in any class that are 340B-savings eligible — so they can pass-along those savings to patients in need.
Using savings from 340B programs to support outpatient programs
One of the single most cost-effective programs for any hospital — much less 340B-eligible DSHs — is Meds To Beds; or bedside delivery of patients’ discharge prescriptions. We often hear health systems (with and without 340B programs) complain that they can’t afford to maintain a robust Meds To Beds program. Our response: You can’t afford not to.
ProxsysRx has implemented Meds To Beds programs for dozens of health systems, many with 340B programs, and the lowest reductions we’ve helped them achieve in medication-related readmissions is 20%.
For one health system ProxsysRx serves in Mississippi (Southwest Mississippi Regional Medical Center), our Meds To Beds team filled over 18,000 discharge prescriptions during the very first year of our program. During that time, the hospital’s retail pharmacy revenues increased 125% and its patient readmissions decreased 79%.
Simple math for 340B programs
A well-managed 340B program can generate millions in annual savings and revenue for a single hospital. A well-managed Meds To Beds program costs a fraction of that. Therefore, by dedicating a fraction of the savings and revenue their 340B programs generate, to support their Meds To Beds programs, hospitals can significantly increase revenue and patient-care quality — thereby positively impacting their Value-Based Care scores.
At the same time, many of the hospitals we support with 340B programs use their savings and revenue to improve patients’ access to quality healthcare. As Conway Medical Center Director Of Pharmacy Andrew Wright reported in a previous post, “It’s allowed us to expand into areas of medicine we never thought we could offer. We’ve added a cancer center, a pain clinic as part of our orthopedic practice, a dermatology clinic, and a women’s center. We’re expanding our footprint, and we’re treating so many more patients than we used-to. Without ProxsysRx and its 340B programs, that wouldn’t have been possible.”
Using 340B programs to increase patient access to medications
The cost of prescriptions isn’t the only barrier keeping patients from following their medication protocols. Many patients lack access to the transportation needed to take them to and from pharmacies — particularly when there are no pharmacies nearby. Which is why your outpatient pharmacy should also offer home prescription delivery. Again, when health systems’ outpatient pharmacies don’t offer prescription delivery service, they should consider dedicating a percentage of their 340B programs’ revenue to adding that service.
Using 340B programs to improve patient education and follow-up
The last primary reasons patients don’t effectively follow their prescription protocols are confusion and complications. In a well-run Meds To Beds program, pharmacists are available to thoroughly discuss all medication-related issues — to ensure that patients and their caregivers know and understand what their prescriptions call for.
At the same time, Meds To Beds pharmacists often uncover potential medication-related conflicts that could occur between patients’ discharge prescriptions and their existing prescriptions — and will report those problems to the patients’ providers.
After discharge, the best Meds To Beds programs include 30-day Readmission Risk Reduction patient follow-up programs — with pharmacists phoning patients personally, to ensure that they’re still following their prescription protocols, and to answer any questions that patients may have since they left the hospital.
Once again, all these initiatives can be funded, in part, by well-managed 340B programs. And once again, all these initiatives — if well-managed — will deliver returns far beyond their costs, both in terms of savings & revenue and value-based care scores.
What are value-based care programs?
As we noted in another previous post, the Centers for Medicare & Medicaid Services has reported that value-based care programs reward health care providers with incentive payments for the quality of care they give to people with Medicare. Value-based care programs have three primary goals: 1) Ensuring better-quality care for individual patients. 2) Improving the overall health for populations. 3) Lowering the costs of healthcare.
The impact of Medicare patient readmissions on health systems
Medicare closely monitors health care providers’ readmission rates. If it determines a given health care system has too many readmissions, it can reduce all of that system’s payments by up to 3%.
At the same time, health systems’ physicians are also subject to Merit-Based Incentive Payment System (MIPS) scores. Physicians serving hospitals with high rates of patient readmissions can be easily dinged with low MIPS scores — scores that are often unfair, and largely due to medication non-compliance-related readmissions. One too many dings on a physician’s MIPS score may lead them to move their practices to other health systems.
ProxsysRx is here to help, if you have questions.
There are so many ways to optimize the savings and benefits of health systems’ 340B drug programs to support their value-based care objectives. For more information, contact Howard Hall. C: 214.808.2700 | howard.hall@proxsysrx.com
