Russ Procopio is executive vice president of the post-acute pharmacy team at Managed Health Care Associates, Inc. (MHA). Procopio has 30 years of experience across healthcare, including the provider side, manufacturers, wholesalers, and now the group purchasing organization (GPO) and pharmacy services administrative organization (PSAO) segments.
MHA’s post-acute pharmacy team is the commercial organization that manages closed-door pharmacy, long-term care (LTC) pharmacy, and home infusion specialty pharmacy members. In this interview with Will Lockwood, ComputerTalk’s director of editorial content, Procopio discusses ways these pharmacy segments can boost revenue.
ComputerTalk: Russ, post-acute care pharmacy is a great area for pharmacies looking to build new services and revenue. What are your members, who are already in these markets, doing to boost their revenue?
Russ Procopio: One way our post-acute care members are building new revenue is by reviewing the services that they provide patients and facilities and identifying those that are not reimbursed. For example, they can assess if there are opportunities to partner with the facilities they serve in order to create performance-sharing arrangements that would help increase the facility’s star ratings. This review of services is the most attainable approach and quickest to market, which is why I say it’s up there on the list.
CT: What’s the conversation like between the pharmacy and facilities?
Procopio: Well, all of our members provide the same high level of service to the patients they care for, whether the payer is Medicare, Medicaid, or commercial. They provide a wide array of services and support that aren’t always recognized by payers, but which generate documented positive outcomes. This level of service, and the outcomes, often aren’t well communicated.
This creates an opportunity for pharmacies to create what I call “value optics” for facilities and payers. What I mean by that is that the pharmacy works to educate its partners and show them that the pharmacy isn’t just dispensing medicine. They’re actually wrapping their arms around the patient and providing care that goes above and beyond. The pharmacy then explains the cost to dispense when you take all these additional services into account, whether they are mandated or not, and draws a line to the lower total cost of care that entails.
CT: What are the tools and support MHA offers pharmacies looking to demonstrate this level of service and the lower cost of care they afford?
Procopio: We have an ongoing commitment to ensure that our pharmacy members are always educated around the performance requirements of the contracts that we negotiate with PBMs (pharmacy benefit managers) and health plans. We look for systematic ways to measure and report outcomes. And we are working to provide information and insights back to our members about how these contracts are performing.
Our ultimate goal is to identify any areas where our pharmacy members are generating outcomes and providing value above and beyond the contracted requirements, and seek reimbursement for that value.
CT: That is powerful information to take to facilities and payers.
Procopio: Yes. We want to make sure that our members are able to educate facilities, payers, and health plans about how valuable pharmacy services are. We want our pharmacy members to be able to communicate about the positive outcomes that they are achieving that are aligned with improved patient health and lower cost of care.
CT: OK. What’s your number-two area?
Procopio: We expect to see the home care, or medical at home, market grow strongly. This market is relatively small compared to areas such as behavioral health and traditional skilled care, but we believe that it will see double-digit compound annual growth rates (CAGRs) over the next five years. The larger markets will likely have CAGRs of only 3% or less. I wholeheartedly believe that medical at home will be an important market that our traditional closed, long-term care pharmacies can tap into.
CT: What can pharmacies do to participate in this growth?
Procopio: They can educate themselves about the market. For example, the 2023 MHA Business Summit is coming up March 15–17. And at that summit we will provide continuing education opportunities for our pharmacy members to understand how to take part in the medical-at-home market. We will address topics such as: How can a pharmacy create a business case for its potential medical-at-home patient base? How do you analyze the total available market?
How do you create the clinical protocols that deliver the same LTC level of care for medical-at-home patients and ensure that you are doing more than just fulfillment of the drug? How do you create that continuum-of-care network? These are the questions pharmacies need to be answering if they want to compete with the larger regional and national providers that will be looking to serve medical-at-home patients too.
CT: What’s driving this market’s growth?
Procopio: Home health exists today, of course. But what we are seeing is more and more migration away from traditional skilled-care settings. When patients get discharged from acute-care settings, instead of going right to skilled care, they’ll go either directly home or home via assisted living.
CT: MHA serves its members both as a GPO and a PSAO. What are pharmacies’ expectations for these services today?
Procopio: They expect a high level of service excellence, just as a baseline. They are looking for the best total economic value, of course. But they are also looking for strategic value. Pharmacies are asking who will be the partner that can execute against a strategy that helps the pharmacy increase its value. They are looking for a partner that makes an impact in the long run, beyond any short term benefits of having, for example, more vendor relationships than a competitor.
At MHA we do the work of negotiating contracts and building vendor relationships, but we also understand that our members are sophisticated and have complex needs. And so we must change and evolve in ways that strategically drive value. CT