Program Overview
Purpose
This program will work with a subsection of BCBSM commercial population which covers various state employees and large employer groups. The purpose of this program is to present pharmacists with patient care opportunities for review and intervention to drive improvement in patient care gaps.
Quality Measures
The quality measures targeted for the BCBSM program are as follows:
D08: Medication Adherence for Diabetes Medications
D09: Medication Adherence for Hypertension
D10: Medication Adherence for Cholesterol
SPD: Statin Therapy for Patients with Diabetes
SPC: Statin Therapy for Patients with Cardiovascular Disease
AIS: Adult Immunization Status
IMA: Immunizations for Adolescents
PRS: Prenatal Immunization Status
Pharmacy Services (Tasks)
The tasks within the BCBSM DocStation program are as follows:
Adult Immunization Screening:*
Adolescent Immunization Screening:*
Prenatal Immunization Screening:*
*Note: services being added in current DocStation development cycle; workflow guides will be linked upon completion of cycle
Pharmacy Reimbursement
The BCBSM program will pay pharmacies for both completing tasks and end-of-year member outcomes.
Completed Task: the task is addressed by the pharmacist, leading to a successful encounter with a patient resulting in 1 or more clinical intervention(s).
Tasks | Completed Task |
Non-Adherence by Medication Class | $10 |
Statin Use in Persons with Diabetes | $10 |
Statin Use in Persons with Cardiovascular Disease | $10 |
Adult Immunization Screening | $10 |
Adolescent Immunization Screening | $10 |
Prenatal Immunization Screening | $10 |
Outcome Bonus: end of year bonus payment paid once quality measurements are finalized in April of the following year. Pharmacies are eligible for bonuses for each assigned member who is eligible for the quality measure.
Tasks | Outcome Bonus |
D08: Medication Adherence for Diabetes Medications | $90 |
D09: Medication Adherence for Hypertension (RAS antagonists) | $90 |
D10: Medication Adherence for Cholesterol | $90 |
SPD: Statin Therapy for Patients with Diabetes | $90 |
SPC: Statin Therapy for Patients with Cardiovascular Disease | $90 |
AIS: Adult Immunization Status | $90 |
IMA: Immunizations for Adolescents | $90 |
PRS: Prenatal Immunization Status | $90 |
Note: to be eligible for outcome bonus, pharmacy must have completed tasks occurring prior to gap closure
Support
Still have questions? No problem! Contact the DocStation Support Team in the blue chat bubble or at support@docstation.co