Navigate the Changing Landscape of DIR (Direct and Indirect Remuneration) Fees and Maximize Patient Engagement with EQUIPP^®

The new year brings new changes for pharmacies, and 2024 is no exception. With the shift of DIR fees to point of sale and ongoing adjustments to performance expectations, it’s more important than ever for pharmacies to stay informed and adapt their strategies. Here’s a quick guide to navigating these changes by leveraging EQUIPP as a powerful tool for success.

Key Takeaways:

• A New Reimbursement Landscape:  DIR fees are now impacting reimbursement at the point of sale, and the focus on quality measures and patient engagement remains paramount. EQUIPP continues to be your go-to platform for accessing performance data, tracking goals, and identifying areas for improvement to maximize reimbursement in performance and clinical care programs.
• Data Availability in EQUIPP: Continuous performance data for various periods displays in EQUIPP include rolling 6-Month and Year-to-Date measurement periods. The February 2024 refresh will provide complete year to date data for 2023, while March and April updates will begin to include 2024 performance available in the rolling 6-Month view.
• Payer Program Updates: For 2024, most network programs are continuing to offer performance-based incentives tied to your pharmacy’s performance in quality measures. Focus on understanding your goals based on network or NPI level evaluations.
• Developing Your Action Plan: Quality improvement takes a team. Incorporate your staff in creating a plan to utilize EQUIPP effectively. Assign a quality champion to monitor performance and create a strategy based on health plan priorities and patient demographics.
• Leveraging EQUIPP Features: Use EQUIPP to analyze measure performance data, identify patients needing intervention, and track progress towards your quality goals. Review the Quality Improvement Program (QIP) table for specific health plan expectations. For many plans, achieving a 4- or 5-star goal will unlock significant revenue for your pharmacy.
• Revenue Opportunities: Enhanced Services programs provide additional ways to earn revenue by engaging with patients and completing documentation for specific programs. You can also review patient records and understand other bonus opportunities based on the designations available.

Remember:

• Utilize EQUIPP as your key resource for accessing data, understanding goals, and identifying patient improvement opportunities.
• Review performance data frequently and adapt your strategy based on specific reimbursement priorities and health plan expectations. Patient updates may be available weekly to promote continuous improvement opportunities and engagement.
• Engage your staff and leverage their expertise to optimize patient care and achieve performance goals.
• Explore revenue opportunities through enhanced services programs and patient designations.
• Maintain open communication with your PSAOs and managed care teams to ensure clear understanding of contracted performance network expectations and goals.

By staying informed, adapting your strategy, and utilizing EQUIPP effectively, you can navigate the changing pharmacy landscape in 2024 to achieve continued success.

We at PQS will continue to help you navigate the evolving pharmacy landscape in 2024 and answer your EQUIPP questions. For further information and updates, stay tuned for future blog posts and webinars from PQS and EQUIPP. You can also reach out to us directly with your questions at support.pharmacyquality.com.