Among the topics regularly covered on the Thriving Pharmacist are several articles discussing rewards for performance paid to pharmacies. Few of the examples shared here, unfortunately, are actually representative of pay for performance. Today, I will share yet another pay-for-performance program that misses the mark.

This program is regional, and is called Intervention Messaging, or IMRx. It is designed to increase medication adherence using real time alerts sent to the pharmacy during the claim adjudication cycle.  The plan is supposed to benefit both the patient and the pharmacy by paying the pharmacy an incentive fee for each adherence conversation they have with the patient. Payment is dependent on the patient filling the offending (late, unfilled) maintenance prescription.

Like most programs, there are positive benefits to the pharmacy:

  • The incentive payment is welcome revenue
  • The pharmacy should see additional fills, which adds additional revenue
  • The pharmacy’s adherence measures should be positively impacted, assuming the medication flagged by the program falls in an EQuIPP category.

These are all true, and one cannot contest the positives. But the program misses the point. It only addresses a problem after it has occurred. If a pharmacy successfully addresses the noncompliance , the reward becomes a one-time bonus unless the patient falls back into non-compliance. A pharmacy that is  proactive with adherence management, using MedSync and motivational interviewing techniques to ensure high levels of patient compliance, would see no reward for their work and high performance.

There should be two parts to any performance incentive: an incentive to improve, and an incentive to maintain high performance. This program, like many that have come before it, fails to address the last part. Just like pharmacists caring for patients, the performance incentive programs need to make every encounter count.