Escalating healthcare costs resulting in national and state healthcare reform efforts have created an opportunity and urgency for pharmacists to integrate into established and emerging systems of reimbursement for patient care services. Numerous studies demonstrate the value of pharmacist-provided patient care, however current business models are unsustainable due to the pharmacist providers inability to bill for their services. Washington State has an ideal situation for increasing the recognition of pharmacists as service providers due to our Pharmacy Practice Act, which permits participation in Collaborative Drug Therapy Agreements, and an Every Category of Provider Law requiring health plans to pay all providers for covered services within their scope of practice while preventing health plans from excluding entire categories of providers from their provider network. The CPF Focus Grant will be used to research, develop and test a model for community pharmacists in any state to become credentialed as covered service providers within health plans. We will work with health plans, the state Insurance Commissioners Office, universities and associations representing other healthcare providers to develop educational tools such as website content, web-ready presentations and guides for distribution which explain the credentialing and contracting processes and walk pharmacists through the necessary steps to become credentialed providers. We will test this model throughout Washington State in urban and rural communities and collect relevant data including but not limited to the number of pharmacists that have completed the credentialing processes of major health plans through this model and unidentified barriers. Credentialing is the entry point into health plan privileging and contracting processes necessary for pharmacists to become eligible service providers, which is a critical component required to achieve sustainable change within the pharmacy business model.
Washington State Pharmacy Association