Readiness for Payer Opportunities
1) Documenting care plans prior to a payer program helps pharmacies hit the ground running for when contracts are signed for services and documentation of the services rendered.
The 'putting the pedal to the metal' mantra from the start is not the best way to go about documenting comprehensive care plans for patients within a payer program. We have seen with pilot programs with payers and active engagements with payers that demonstrate it is nearly impossible to start at 0 MPH and then go to 60 MPH successfully.
It is much easier if we can get at a steady 25 or 30 MPH over time and then when the payer comes, we can increase to 60 mph much easier after the payer program starts.
CPESN USA is telling payers that they should “expect more” from CPESN pharmacies and we want to deliver on that promise.
2) Payers want a network that is ready to go. They are expecting that CPESN pharmacies are comfortable care planning in their technology systems right out of the gate.
Increasingly, payers are requiring for pharmacies to document comprehensive care plans for patients before they can proceed with the payer opportunity.
Payers want to make sure pharmacies can document the care plan components that are important to them, which are typically more enhanced than what CPESN USA is asking of CPESN pharmacies currently. If pharmacies are already documenting the basics, then the next level will be easier.
Payer budgets are going unspent because pharmacies are not ready to document care plans for patients.