A conceptual value-based incentivization model of adult immunization for community pharmacists

Abstract

Objective: To design a value-based payment model to incentivize pharmacists for increased administration of influenza, herpes zoster, pertussis-containing, and pneumococcal vaccines to adults at community pharmacies.

Design: A modified delphi technique was used to create a concept for a value-based payment model through consensus of expert opinion.

Setting: and participants: Experts were recruited from a regional supermarket pharmacy, a self-insured employer, a managed care organization, and an academic institution to participate in 4 electronic surveys and 1 in-person meeting.

Outcome measures: Consensus on model design by means of a modified delphi technique.

Results: A panel of 11 experts participated in a series of electronic surveys and 1 in-person meeting. The final value-based payment model addressed how and when pharmacists would receive an incentive for meeting specific vaccination goals. The final value-based payment model also addressed the following concepts: estimated cost avoidance, vaccine effectiveness, and community protection. A 3-tiered incentive model was agreed on by the participants to tie increased vaccination rates with increased payment. Vaccination goals for each tier were defined as the percent increase in vaccination rates from the year immediately preceding. Incentives were defined as a percentage of estimated direct medical costs avoided to be shared between the payer and pharmacy.

Conclusion: A conceptual value-based payment model to incentivize pharmacists for increased delivery of adult vaccinations at community pharmacies was designed and agreed on by experts representing a regional supermarket pharmacy, a self-insured employer, a managed care organization, and an academic institution. Consensus was achieved by aligning the interests of both payers and pharmacies. The final model included 3 tiers of bundled incentives to reward percent increases in adult vaccination from historical baselines. This model may be used as an example for community pharmacies and health care payers to design future value-based immunization programs.