Clinical, non-PBM pharmacy growth is not only possible, but it can be easy to implement, help your patients, and boost your profits with remote patient monitoring and chronic care management.
Pharmacists play a pivotal role in patient care, offering essential services such as medication reviews and patient education. However, these valuable services often go unrewarded in the face of shrinking prescription reimbursements and escalating DIR fees.
The challenge is finding the extra time required to provide comprehensive care to each patient while still being able to pay the bills. Many pharmacy owners are desperate to increase non-PBM revenue for their independent pharmacy. Breaking free from the PBMs allows pharmacy owners to be in more control of income, their services, and their patients’ health.
Let’s explore how pharmacists can partner with physicians to leverage Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) services. Medicare and other insurers pay for these services, as they save overall spending on healthcare by keeping patients healthier and preventing expensive hospital stays. While Medicare does not recognize pharmacists as providers, we can still provide services, get paid for them, and help our patients.
Medicare’s Evolution in Patient Care:
Medicare has introduced a range of programs aimed at delivering patient care beyond traditional office visits. These initiatives aim to reduce unnecessary emergency department visits, hospitalizations, readmissions, and overall healthcare costs. The journey began with a single CPT Code 99490 in 2015, and in 2023, it includes over 25 billable codes across various patient programs. Payers see the value in these services, and you should, too. We’ll focus on two key programs: RPM and CCM.
RPM: Enhancing Care Remotely
Remote Patient Monitoring (RPM) is a Medicare program that empowers patients to use digital medical devices, such as blood pressure monitors and scales, which automatically transmit their readings to healthcare providers. These devices and data enable physicians to remotely track and monitor patients’ health data from the comfort of the patient’s homes. By doing so, healthcare teams can provide timely interventions and care adjustments, ultimately improving patient outcomes and reducing healthcare costs.
CCM: Managing Chronic Conditions Effectively
Chronic Care Management (CCM) is another Medicare program designed to enhance the well-being of patients dealing with two or more chronic conditions. It involves healthcare providers proactively coordinating and managing the care of these patients. Services offered include medication management, care plan development, and regular communication to ensure patients receive consistent, high-quality care. CCM aims to enhance patient outcomes, reduce hospitalizations, and foster a more patient-centered approach to managing chronic illnesses.
Unlocking Revenue Potential for Pharmacies:
While pharmacists currently cannot bill Medicare directly for RPM and CCM services, there is a solution. Practitioners who can bill Medicare have the option to hire additional staff or outsource to deliver these services to their patients. We prefer a more synergistic, local approach—partnering with local independent pharmacies. Patients are already familiar with their pharmacy’s staff, and pharmacists are well-equipped to provide these services. This collaboration benefits both patients and pharmacies, offering an additional revenue stream.
By enrolling your patients into RPM and/or CCM, many of the activities and the time your staff is spending with patients can now become billable time. Many pharmacy owners often wonder how in the world they will add services to their busy pharmacies. With RPM and CCM services, you will need to do some extra work, BUT… the magic is that much of the work you are doing now and getting paid nothing will now become time you are paid for.
Financial Gains for Your Independent Pharmacy
Pharmacies implementing RPM and CCM can generate $40 to $100+ per patient per month. It’s time to leverage your pharmacy’s potential, enhance patient care, and boost your income. With 200 patients monitored, this can translate to approximately $8,000 to $20,000 per month in revenue.
DiversifyRx has had a focus on RPM since our inception. Many of our members have successfully implemented programs of all sizes. Here are some examples. Amanda has grown her program to about 80 patients in 4 months and nets approximately $6,500 every month. Or Andy, who in the first 6 months of 2023 has enrolled over 600 patients and has added about $50,000 a month to his bottom line.
So… where do you begin?
You Need A Partner
RPM, CCM, and many other value-based care services are unique in that technology and software must be utilized. So, you must have software that enhances your services, tracks all the data, and makes billing a breeze. Our favorite partner is ValueCare Suite. Their software not only kicks ass, but they have more experience in helping independent pharmacy owners perform, bill, and run these programs than anyone else.
It Can Be Confusing, At The Beginning
- How do you approach a doctor?
- What do you show them?
- How do you write a service agreement?
- How do you send them billing?
Lots of questions will pop up. You need someone who can walk you step-by-step through every single stage of launching, growing, and then sustaining these programs. ValueCare Suite is your best bet.
To embark on this journey, start exploring.
Begin with talking with RPM/CCM software providers and get a good foundation of what these programs require. We highly recommend you do research and understand some details before you approach any physician.
You don’t have to hire a bunch of new people! Most pharmacies start with their current staff to get the program up and running. Even on a scale of several hundred patients, the amount of staff requirements is low.
Pharmacists are more than essential, and we know pharmacists and, especially independent pharmacy owners, are vital. It’s time to be compensated for the exceptional care you are already giving. By embracing RPM and CCM services and collaborating with physicians, pharmacists can not only enhance patient care but also unlock a new revenue stream. It’s a win-win situation for both patients and pharmacies, leading to better healthcare outcomes and financial sustainability in an evolving healthcare landscape.