With the increasing shift of provider reimbursement being tied to value or quality, each year brings about new programs and priorities focused on increasing value, which is now becoming more commonplace for the profession of pharmacy. As EQuIPP begins to host performance for additional programs in 2016, it is helpful to familiarize yourself with some of the terms and acronyms associated with these new programs:
Pay for Performance (P4P) - A term which indicates that reimbursement, compensation, or bonus incentives are tied to reaching defined goals. Many pharmacy P4P programs involve an incentive payment for achieving a certain level of performance and/or improvement on medication-related quality measures (e.g. medication adherence scores) during a defined time period such as 6 or 12 months.
Quality Based Network (QBN) - A term that a health plan or PBM may use to denote that performance on medication-related quality measures or other pharmacy-related measures are key aspects to participating network pharmacies.
Value Based Contracting - A term which indicates that provider contracting involves alternative payment methodologies where accountability to provide value such as quality performance or cost-efficiency is a key component of the agreement. Some contracts may reward or incentivize providers for achieving higher levels of performance and, consequently, may also withhold payments for lower performance.