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Green Shield Canada

Episode 10: Value-based Benefits

Episode 10: And now for something completely indifferent
In episode 10, hosts Sarah and David celebrate the recording of the tenth podcast and discuss the topic of value-based benefits with guests Ned Pojskic, GSC’s Leader of Pharmacy and Health Provider Relations, and William Chung, Shoppers Drug Mart’s Senior Vice President of Payor Partnerships and Pricing.
And now for something completely indifferent

And now for something completely indifferent

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Episode 10 Transcript


[0:00:15.4] SM: Hello and welcome to another episode of GSC’s podcast, And Now For Something Completely Indifferent. Where we’ll be discussing the hottest topics and trends in Canadian health benefits. I am one of your hosts, Sarah Murphy.

Before we get started with today’s episode, we would like to remind our listeners that the views expressed in this podcast are those of the individuals speaking and not necessarily the views of GSC. We may talk about sensitive and even possibly controversial subjects. Therefore, reserve the right to potentially offend some listeners but are apologizing for it out front.

You can download this podcast from our website at or subscribe to it from wherever you get your podcasts. We also encourage you to read our publications, The Inside Story and Follow the Script which you can also download from our website and please be sure to follow the conversation on Twitter and LinkedIn.

Now, let’s get started. Today’s episode is hosted by David Willows. GSC’s Chief Innovation and Marketing Officer.


[0:01:16.5] DW: Thank you Sarah. This is a special occasion I think in the podcast studio. Tell the world how many times it has heard you do that identical intro?

[0:01:28.3] NP: 10 times. It’s a big day.

[0:01:30.6] DW: We’ve done 10 podcasts.

[0:01:32.4] NP Happy 10th anniversary GSC podcast.

[0:01:35.5] DW: Yeah. I mean, people go back and listen to the first couple, we didn’t think we’d get 10 listeners, including us, yes. We didn’t think we’d get eight more but we’ve done 10 now and it appears that we do have more than 10 listeners based on the amount of feedback we get and amount of feedback our guests get as well, certainly from our guests.

[0:01:54.0] NP Yeah.

[0:01:55.4] DW: We’re not going to do our silly talk thing much today at all because we have someone that we’ve been trying to get on the podcast. I will say, when this was just a gleam in our eye, this podcast, we had sort of this wish list of people we’d like to get on and we have had a few of them.

[0:02:09.4] NP Famous Canadians?

[0:02:10.0] DW: Yeah. I remember Steven Frank was a big deal for us.

[0:02:12.7] NP Peter Grove. Oh no.

[0:02:13.3] DW: No, yes. Don’t feed the Grove monster. But this fellow today, William Chung from Shopper’s Drug Mart was on that first list. We had met William many times before in different business venues.

But he’s good at talking and yeah, he has a lot of interesting things to say and as is our want today, we asked him to come in and talk about a very hot issue which is value based benefits and specifically, value based pharmacy and we did encourage him to take us on a bit.

And say what he didn’t like about our current initiative around value based pharmacy and I think he gives us a very sort of balanced view of that but it’s an important topic I think for our industry and it’s more broadly an important topic for healthcare. How we drive value into it so we don’t want to take too much time today, we want to get right to William and our colleague Ned Pojskic talking about this issue and here we go.


[0:03:08.9] DW: Today in our podcast studio, we have an old friend of the podcast, our colleague Ned Pojskic who is our Leader of Pharmacy and Health Provider Relations and we have a very special guest from outside GSC. A person that we had on a list of people we hope to get into podcast studio at some point. His name is William Chung and he is the Senior Vice President of Pair Partnerships and Pricing at a little company called Shoppers Drug Mart.

Thinking that our listeners may have heard of that one, I probably don’t have to ask you to explain.

[0:03:36.9] NP Probably not.

[0:03:37.2] DW: What that company does. But William, I’m going to ask you sort of, tell us a bit about your world and how did you end up in a job like that at a place like Shopper’s Drug Mart?

[0:03:47.8] WC: Gosh, okay. I only have half an hour for this podcast.

[0:03:50.4] DW: We can edit.

[0:03:52.0] WC: I actually came into the industry about 28 years ago. I started as a pharmacist and I still hold my license but if you see me in a drug store, you should run fast.

[0:03:59.7] DW: Okay, we appreciate that honesty.

[0:04:02.0] WC: Yeah. You said I’m currently Senior Vice President at SDM and I take care of a number of functions. I look after our financial planning and analysis group who looks after annual budget, pricing of pharmaceuticals, pair partnerships and I actually have two teams that work with our pairs.

One team works for the back end of value chain but folks like Green Shield, folks like Great West Life and with the carrier community to look at really developing programs that leverages with the capabilities of pharmacy. To make sure that we maximize what the value of profession is to healthcare system.

Then I have another team that works primarily with the PBM industry to look at day to day transactional things that we’re doing to make sure that we run efficiently on both sides.

Then the last practice that I lead is the MNA group for enterprise. I came to Shoppers, gosh, it must be about four years now and prior to this, I was head of pharmacy at Rock Salt.

[0:05:03.2] DW: Okay.

[0:05:04.0] WC: Who is part of the –

[0:05:04.7] DW: We’ve heard of them too.

[0:05:06.1] WC: Now, yes. Prior to that, kind of built a little startup company called MediSystems who is a long term care provider and then in between that kind of worked in a brief stint with [inaudible].

[0:05:17.4] DW: Okay, great. That’s very helpful. I know for me and my listeners and a couple of times there, I think you used the word value and that’s a bit about why we’re here in the podcast studio today to talk about the concept of value based healthcare, value based benefits and I’m going to ask Ned to give us a bit of an introduction to the concept of value based, when it comes to health benefits and then as this podcast goes on, we’re going to talk about very specifically about initiative that we started in the last year called value based pharmacy which I think William will have some insight on as well so Ned, over to you.

[0:05:54.9] NP: Yeah, thank you, you’re going to have to hear me about this again because I know you heard it a million times, indulge me one more time on the notion of value and what we’ve been talking about.

Generally speaking, value as a concept I think is well understood. In healthcare it is a relatively new concept and it’s closely tied to the concept of quality. The idea that we measure any aspect of our healthcare system, whether it is quality of care delivered at a hospital or quality of care delivered by healthcare provider, we measure quality and then we assign a certain value to it, we are saying, quality delivery of healthcare leads to better outcomes which means there is value in that particular delivery.

The notion of quality itself however I think is brand new in healthcare generally, we’ve never really thought of our healthcare system as not having quality, we’ve always assumed it’s built in, right?

You know, healthcare providers as an example, they graduate from their respective colleges and universities, they get licensed by the regulatory colleges, they’re perfect providers and we really have nothing to worry about that kind of thing. I think over the last decade, the notion of quality has started to take hold the idea that we actually have to measure what happens in practice.

Aside from the safety dimension which is always addressed by regulatory colleges. We’ve got to look at what’s happening in practice, where is the quality bar, be able to measure it and then assign certain, if you will, value to it.

This is again new concept in Canada and on Ontario even more explicitly but it’s not a new concept internationally. We’ve seen it in the UK, we see it in the United States and it’s almost built in, it’s ubiquitous in those systems that qualities measured reported on, acted upon rewarded, penalized, however you will, from different perspectives.

[0:07:32.6] DW: Those countries tend to have better health outcomes as measured than Canada? Where are we stacking up there?

[0:07:39.1] NP: That is probably arguable, they may have better performance on certain aspects of the healthcare system, they underperform kind of this healthcare system with other measures. That’s I think fully acknowledged.

It’s a little bit difficult to tie, you know, what measurement of quality to ultimate outcomes to those systems because there are so many variables that ultimately play a role but it’s an important component of how you actually eventually get to outcomes.

[0:08:02.3] DW: Okay, got it. William, as Ned suggest, there’s been more and more dialogue about this concept of value in healthcare. I’m hesitant to ask you to speak on behalf of Canadian pharmacy but you're the only one here.

[0:08:15.0] WC: I will try.

[0:08:15.6] DW: In the podcast today. What’s your perception of how the Canadian pharmacy community has been talking about and planning for what is likely to become more value based world?

[0:08:28.3] WC: Yeah, I would say, to be honest, prior to the Green Shield announcement. I would say activity has been going on but in terms of regular agenda items, it’s been relatively silent.

[0:08:40.8] DW: Okay.

[0:08:42.2] WC: That’s because we have a lot of other things on a macro level with that’s affecting our industry today. Not that you know, the value of the quality aspects are not important. But you know, as Ned mentioned, In other parts and other jurisdictions globally, it’s not a new phenomenon, right?

We have seen it particularly, I’ll speak about the pharmacy aspects of quality.

[0:09:03.5] DW: Yeah, please.

[0:09:04.7] WC Because I think that’s really the scope of today’s discussion. We’ve seen that in the US, for a number of years now, they have had these quality rating systems, now, the quality rating system as we understand it is at a health plan level. Now, because number one structurally, the US is very different than in Canada in terms of the payer systems.

But besides that, they have actually ascribed quality measures at a health plan level and it just so happens that pharmacy is a participant or a stake holder in the health plan.

[0:09:34.3] DW: One of many.

[0:09:35.2] WC: And, it just so happens, in the US that my understanding is the majority of those measures, more than kind of 50%, pharmacy kind of indirectly or directly involved them. Meaning that it’s important as the stake holder within that value chain that they get pharmacies input and they see how pharmacy may be able to influence it and so on.

When Green Shield announced this, I would say that you know, you're a catalyst in terms of the movement in Canada. Particularly around value based, whether you call it metrics or reimbursement in pharmacy. You know, pharmacy in general, we’re always looking for more sustainable reimbursement model, right?

Currently, we know that the fee for service model which is very transactional in nature which is via volume driven is somewhat shortsighted and myopic in terms of creating that sustainability because that’s what the various regulators and the government is looking at.

It’s not only for pharmacies, looking for other types of healthcare practitioners who are meeting the physicians, right? How do we get away from a more transactional type of payment scheme into something which you’re looking at the patient perhaps more holistically and perhaps driving towards some type of, I’ll call an aspirational measure. Of looking at well, how do we make this patient live longer, how do we make sure that they feel better, right?

Having said that, although that’s the ideal outcome, we know that that’s aspirational in nature and you know, to our knowledge in the industry, there haven’t been a lot of stakes that’s been put in the ground in terms of what this might look like, we have various hypothesis that might be going on in terms of what a quality measurement system might look like for pharmacy but really, no one has really put a stake in their ground.

Which I think is part of the challenges that we’re facing as an industry, right? With the Green Shield initiative. I know that we’ll talk about that kind of later on. Now, I would say that because of what Green Shield has put forth, we are awakened as an industry and not only I would say at some of the chain pharmacy levels or you know, some of the banner of pharmacy levels but I would say, also on a national level as well.

You know, that we have formed a working group with the Canadian Pharmacist Association and we want it to be proactive and we want it to make sure that we’re helping green shield and become an important advisor along the way to hopefully shed some light to hopefully share our perspectives.

In terms of – if Green Shield is thinking about rolling out a system like this, what other aspect might they want to think about, right? We really appreciate the collaboration so far with all of the Green Shield team and with your partners in terms of the quality rating system.

We kind of look forward to really the next phases, right? Of the few months that we’ll be working together in hopes that will eventually be able to come up with some type of a reimbursement system that hopefully will be sustainable for pharmacy.

[0:12:51.4] NP: Absolutely. I’ll comment on that as well. I mean, it’s been an incredible partnership so far from Shoppers, however, a very thoughtful approach that recognizes the challenges and the rapid change that this is introducing I think give some ways to Canadian pharmacy landscape but does so in a responsible and thoughtful manner so I will definitely acknowledge you for that.

I do want to just add on comment on - William mentioned sort of the United States and what’s happening with the health plans down in the states and I think that’s a really important point. I think we lack that in the Canadian healthcare system or in the Canadian private payer systems, specifically.

We don’t have those metrics on the health plans themselves and we’re introducing this in the absence of that. But that type of a system really should exist in Canada as well. I mean, for one, I think we come out very favorably on t hose metrics as GSC would. But at the same time I think, that overall framework kind of system will be very helpful in holding everybody accountable including health plans themselves, so I agree completely.

[0:13:42.6] DW: I just take us back a little bit and probably fair for our listeners Ned, who may not be part of a GSC plan or all these CR press releases and newsletters that we put out there. Briefly describe to people, we have this thing called by base pharmacy, it’s been alive for since last year but just tell people what it is that we have put into play?

[0:14:02.9] NP: Fundamentally, it is equality assessment framework for community pharmacies across Canada. It is based on a set of eight metrics which comprise with three overall categories. Disease management, so chronic disease or how well they’re being managed. Safety, how the appropriateness of prescribing a certain situation, specifically for the elderly and focus on the three adherence metrics. How adherent our patients to the medication therapies.

These eight metrics together comprise a quality assessment framework and the idea is, each and every of 10,000 community pharmacies across Canada has a very specific score attached to them looking at their performance on those eight metrics each and every month.

It’s real time as you can get in a month but the idea is that we’re continuously measuring quality, reporting back to pharmacy about what’s happening and pharmacy can work with that  data to try to implement quality improvement initiatives. Target specific patients that are indeed driving down that score and we’re sort of jointly working together to improve the care of these patients.

[0:15:03.2] DW: Okay, they’re getting that scorecard on a monthly basis at this point, correct? What do you foresee as sort of the next steps in the evolution of GSC’s value based pharmacy strategy?

[0:15:15.7] NP We’ve been fairly transparent that there are three phases to this particular initiative, the first one of which we’re in right now, which began in October of last year which is simply that reporting aspect and its performance reflection and the ability for pharmacies to understand where they stand on certain metrics.

The second phase is the more of the disclosure to our plan members as to how pharmacies are performing to inform their choice of pharmacy. The idea is you know, at the moment, I think in some ways we’re a little bit guilty in the private insurance space of talking a lot about dispensing fees in the cost and how we can drive the lowest cost provider whereas this is changing that dialogue to say, we’re going to inform our plan members to look to the best provider.

The best pharmacy, not necessarily the cheapest one because ultimately, the cost value and long term in going to the best provider is that you’ll have better health outcomes and lower long term costs.

Finally, phase three as William sort of eluded to is that we have been transparent that there is going to be a pay for performance system implemented that will focus on tying those metrics and to the actual payment that has provided the pharmacies.

Whether that is in a form of dispensing fees or mark ups, this is what we’re working through with the working group and where we will be more actively this summer and again, the idea there is a bit of an accountability framework, right? That ensures that higher quality performers are paid higher level and lower quality performers have certain penalties attached to their reimbursement framework, commensurate with the level of value, they’re providing to our clients, the planned sponsors.

[0:16:42.6] DW: William, I appreciate that you’ve said some nice constructive things about what we’re doing here and you’ve used the word catalyst and we’re proud to be change makers but at the same time, I think we have to keep it real and say that the pharmacy community has had a mixed response to this.

We’ve certainly heard it in a different avenues we’ve gone down in communicating and the different forums we’ve been at wit the pharmacy community. In your mind, what is sort of the good that comes from a private payer like us doing this? And what are some of the concerns in the community about us sort of leading this charge?

[0:17:17.4] WC: Yeah, you know, I would say, in general, the pharmacy industry believes that we need to come up with some type of a reimbursement system. Value based pharmacy for government, in terms of reflecting our efforts in order to, again, get patients back to health faster, get them out of hospital faster, get them to access the care faster and ensuring that that type of reimbursement structure is sustainable going forward, right? I think that’s kind of first and foremost.

I think because of the fact that Green Shield has again put a stake in the ground in terms of this as where they’re moving towards, the industry is now having to react to it because in any type of change, you would expect that there are some people who like it and some people who don’t, right?

You know, in the areas where, and this should be no surprise, right? Because we’ve had very transparent dialogues at Green Shield, not ourselves specifically but at the working group level at CPHA, that there are a number of, call it concerns that the industry is trying to share and in hopes there will be some consideration from the Green Shield side that when systems like this is implemented, that our concerns are heard, right?

Hopefully, in some cases, we might be able to influence some of the outcomes and some of the decisions that are made, right? I would say the concerns, if I can kind of group them without being all over the place, it’s kind of in four areas, right?

I think the first area is in the metrics themselves and because of the fact that I would say that we’re somewhat patriotic Canadians and we always want something made in Canada and it just so happens that this particular system, that Green Shield has decided to roll out, it is a US based system, right?

Nothing wrong with a US based system except that I think from our point of view, sometimes if you look at how that system is designed, if you look at the metrics that’s within that system, perhaps some of the metrics may not reflect some of the clinical practice guidelines which essentially means, how we do things, right?

What medications do we use before others, what types of medication should we use on certain patients and so on. I’ll call it, those algorithms or guidelines that we use in clinical practice may not be the same, in both jurisdictions, okay?

[0:19:43.2] NP: Dan and I are writing all these down.

[0:19:48.6] WC: There may be some concerns that we have regarding the metrics themselves, I think we’ve shared that with Green Shield before because first of all, a lot of those metrics are new to Canadian pharmacy so we are trying to understand it, right? And in understanding it, we have to understand, “Okay well what is the definition behind those metrics?”

So after understanding those definitions, we wanted to make sure that we also apply the same type of calculation parameters based on those metrics. Not that we don’t believe the numbers but it is a validation point to make sure that we feel whatever is being suggested, is being calculated is indeed the score, right?

So there is some kind of sanity check, right?

[0:20:34.1] DW: Yeah, make sure the math is right.

[0:20:36.1] NP: Right, yeah.

[0:20:36.5] WC: And then we want it to make sure that that information is available on a transparent basis. So certainly, the quality scores and the quality score cards are great. You need to make sure that stores access it which I think it’s upon us in pharmacy to make sure that we encourage every single one of the Canadian Pharmacies to know what their score is, right?

And you know ideally, we want to make sure that there is an ability for us to influence, right? So we have pointed out that in a number of cases where the metrics themselves require a physician’s approval in order for us to change a certain behavior or what the patient is taking right?

So certainly, we can do everything we can to call the physician up, to fax them, to dialogue with them but at the end of the day, pharmacy is not the decision maker. Now our understanding is that at this point in the evolution of the program, it is not possible for us to manipulate those metrics in a way that at least acknowledges pharmacy’s effort, right?

Now I don’t know if that is kind of a short coming in the actual metric system itself or that might be a phase two net as we talked about but because of that fact, pharmacy I’d say is a little nervous and that gosh, I am being measured on some things that I may not have total control over, right?

And we are a bit of a control freak, as a profession. So I think metrics themselves is one area where we have concern, right?

The second area of concern is the access in terms of those score cards. And Green Shield has made it clear that in the interim, those score cards will be available to stores free of charge but come at the end of this year or maybe early in 2019 when the system does flip over to a reimbursement system that we’ll have to pay for those access. So cost –

[0:22:47.6] DW: It is like a subscription fee, a licensing fee to get to it. Okay.

[0:22:50.3] WC: Exactly so now again, because pharmacies under tremendous pressure from reforms on our key and now in salon, we have to make sure we budget for that and to be honest, none of us really budgeted for it this year and so cost is an issue. Perhaps having to deal with a US vendor, making sure that the agreements, all those compliance guidelines, all the privacy guidelines meets Canadian standards is a challenge for some organizations that are larger.

And so we have to make sure that we understand and we’re able to access the information in a manner that at least it is not cost prohibitive, right? So cost or access is kind of the second area.

[0:23:38.5] DW: Understood, we run a business here too.

[0:23:40.1] WC: Yeah, the third area which we’re in active discussion with the Green Shield team on, is around the composite of score. So we know that at the end of the day, the eight metrics will be equally weighted in terms of formulating a composite score and our understanding is that that composite score whether it’s out of five but it really doesn’t matter what rating it comes out to be right? So if a composite score and we have not –

I wouldn’t say concerns but we have some ideas that we have shared with Green Shield that perhaps an equal waiting of those metric may not be the way to go. Because if you look at our friends south of the border, certainly the number of metrics they deal with are more than eight.

Certainly some of the metrics we have on the Green Shield score card is not on their score card, right? And so, we feel that perhaps there is a rationale to look at a re-weighting if you would of those metrics. And we share the rationale with Green Shield not to get into all the gory details.

So I think there is maybe some opportunity for us to look at, “Hmm, what can pharmacy really influence? And let’s make sure that we perhaps give pharmacy some benefit in terms of influencing those parameters more,” and things that really is beyond your control or somehow the metrics themselves cannot be corrected in such a way to account for that effort, perhaps right now we should weight it less, okay?

[0:25:12.6] DW: Okay, fair enough.

[0:25:13.5] WC: The last part which is probably the most important to the pharmacy community is what will happen to reimbursement. Because at the end of the day, we’re doing this for an outcome and in this case, the outcome hopefully is to improve overall care for our patients. And I think idealistically we do feel that people who provide better care should be reimbursed more and that is beyond pharmacy. It goes for every link and any practitioner.

But unfortunately, I don’t think we have a medical system today in Canada that really reflects that type of equality in terms of a reimbursement for a practitioner and I might be speaking out of school so you know –

[0:25:51.7] DW: No, no. I don’t think you will get a debate in this room.

[0:25:54.1] WC: Yeah, so I think just the uncertainty around what that proposed structure maybe, I’ll call it skepticism on the pharmacy’s part whether there is going to be a fixed pie and guys, there’s only so much money available and we’re going to divvy up that money, there are, call it some winners and some losers.

In some of the pharmacy communities and some of the pharmacists, there are a little bit of skeptics out there in terms of whether this is really true or not.

[0:26:28.1] DW: No, we have certainly heard that. I mean I think we are a payer, obviously we’re going to try to save money.

[0:26:32.5] NP: Right, I think that is through reward.

[0:26:34.7] WC: Exactly, so I think there is a little bit of skepticism on that and I think what we are really trying to do in working with Green Shield is to say, “Well if you have come up with some type of a reimbursement system, are you really receptive to some feedback from the pharmacy community as a whole or if this is going to be a unilateral decision and it’s dictated upon the pharmacy industry. We certainly don’t want it to be that way.

We hope that it is not going to be that way and I think that is why we have been working very closely with the Green Shield team to see, you know we understand where you are going. We want to be good partners, is there a way to bring a solution on the table that at least we have input into it? We’re helping to shape it and you know what?

May the best man win at the end of the day, right? I think that encapsulates if you would the areas of concern right? For then to us all.

[0:27:30.1] DW: Great job and we appreciate that transparency, that’s what we are trying to do in this podcast. It is not to beat around the bush.

[0:27:35.4] WC: No, that’s for sure.

[0:27:36.2] DW: We are trying to do something that we think is important for the broader health care system. I think we’ve talked about the fact that you know, pharmacy may look at the angle like, “Why us?”

There’s so many different things but I mean in the last net. So why did we go to pharmacy first because we certainly have plans in your new role to try and push it out to the broader health provider world where we reimburse a whole lot of stuff and we want to get there with this as well.

But maybe walk through William’s concerns and say how we are thinking about that in the dialogue we want to have.

[0:28:06.3] NP: No and I think all of those are absolutely legitimate and I think we have acknowledged them and certainly the collaborative aspect, it has every intention to focus on doing this in a collaborative fashion.

I think part of the challenge of this service we have here is that a lot of pharmacies in Canada are seeing what happened down the States and saying, “Are you going to replicate that model?” And that model is absolutely broken in the States, right?

And the relationships between PBMs and pharmacy are in an all-time low partly because quite frankly PBMs in the United States reimburse pharmacies at abysmally low levels, right? If you look at the sheer level of reimbursement in Canada compared to States, we are five times level of reimbursements.

So nobody wants to think - get to the US system because it is not fair to pharmacy. It relies on pharmacists having to be none health professionals to sell non-health products in their stores to survive. That’s not a good system and that doesn’t bode well for our health care.

So I mean I think when it gets to some of those specific concerns, the way we’ve broadly tried to address some of those is to look at structuring the goals that are set for the individual metrics on actual levels of performance, right? So what we sort of said is let’s take the spectrum of all pharmacies across Canada, lay them out on a percentile scale and say, “Where do pharmacies range?” And then set a goal that reflects the performance of the top 40% of all pharmacies.

With the sort of I guess implicit understanding that if top 40% of pharmacies can reach that goal, that it is attainable and reachable because clearly, they’re there already. So can we move the other 60% up to where the 40% is? And if we can, then clearly we should be able to, right? I think that’s the overarching philosophy and again, certainly on the reimbursement side of things, the philosophy is once again, you know can we – Our current system is probably unfair to the good providers’ right?

And that all the energy, effort and time they spend with patients is not rewarded to a level that should be given the energy and effort they are spending. Versus other pharmacies that may not be that invested, that may focus more on volume and expense of quality and I think those are the phrase that I hear a lot in the industry these days is value over volume.

There seems to be the repeating itself time and again as the overarching notion. So I think we are systematically working through the working to try to see where we can meet in the middle on all those aspects.

But some of the pieces around whether the outcome actually moves, whether the physician accepts the recommendation and all of that is also part of performance, right? It’s maybe we need to change the way which we talk to physicians. The mechanisms by which we reach out to them. The relationships we have formed with them or not formed with them are all in some ways under the microscope here, right?

So I think it’s definitely a bigger challenge. It is a bigger workflow challenge. It’s a fundamental cultural challenge in how pharmacies approach things but we have to tread carefully and slowly and I think that is part of the initiative and that’s why it is spread out over the course of three years is to slowly but carefully introduce the concept.

[0:31:13.0] DW: Okay. So the one thing that I have heard of a lot which William brought up is this notion that this is somehow sort of a US solution. And I have been trying to understand when I look at the metrics that are on the score card, what is US about that versus Canadian?

And it just struck me that these are pharmacy 100, this is the lay person talking of course but what do you think of that? Is that just nationalism sort of raising its head and we’re proud and we want it done here? As oppose to learning from something that probably makes sense elsewhere?

[0:31:46.8] NP: Yeah, so I think what we have said is as the Canadian arm of this process gets underway which is CPHA has been a very good thought leader working jointly with the regulatory colleges in Ontario for example, as that gets underway we are fully committed and on board to adopting the Canadian based metrics or systems that come our way. We don’t think that once that process gets underway and plays out, we think it will actually look exactly to what it looks like right now in the States.

Because the thought process leading to these metrics was very much within the mindset of, “Can pharmacies influence these things? What are the priority areas in health care?” And consulting widely to develop the metrics in the system, I think should we go through that process in Canada and if it appears that we are starting to in some early stages of that, I think we will end up probably right back at the same stage or very close to the same stage.

Regardless, when that gets underway, gets developed, we will adopt those metrics wholeheartedly and work with them. We think that this system though originating in the United States is rooted in clinical guidelines that we’ve gone through clinical guideline by clinical guideline to ensure that the Canadian ones are not – it is not identical even “easier” in some ways than the US ones or vice-versa. So the idea here is to really open a lead that it has applicability in our context and we have to go through that.

The other piece of it is that when we selected the eight metrics, it was with that mindset in mind which is there are 33 metrics in the United States. We selected the eight that were applicable in the Canadian context. But again, I fully do understand that they were born in the United States and so that causes some reservations.

[0:33:22.8] DW: Yeah, so I normally ask the questions here but I am going to say one thing with my sort of GSC hat on. We talked about it briefly but sort of this assumption that this is a long term play of reduce costs and we’ll do that by lowering pharmacy reimbursement because they are not going to be able to meet the metrics that we’re putting out there. And I would just say that has never been a conversation inside this building even once.

And I’d like to think that we have a history here at GSC of being quite proactive and I have to say this carefully, in sort of introducing new costs into the system to our plan. I just hope our sponsors and advisors aren’t listening. But we’ve done that based on we want to drive more evidence based, value based benefits into benefits plans and we’ve done that with pharmacist health coaching a few years ago, we’ve done it with dietician health coaching, we’ve got initiative coming off around online cognitive behavioral therapy, sorry if I’m talking about things that are going to be a big splash in about a month or so.

Where we’re actually going out in saying, “We think you should send more in your benefit‘s clan for things that objectively are going to drive better health outcomes.” Certainly, our plan with this as well is, “Hey, if everybody’s hitting it out of the park and pharmacy, you know, the boats of pharmacy rise and we’re getting better work, we’re kind of cool with telling our – the ultimate payers here which are our clients. That’s good.”

Because the long term game here is they’re going to have some healthier people who are going to be less costly to you over time. I want to say, on behalf of GSC, that’s never been a strategy here to reduce reimbursement, ideally, we’re increasing at but we’re getting much more widespread, better health outcomes in the system. I’ll step up and say that.

Sarah is staring at us and she’s got her smart timer on. Her phone is in front of me, it is at 33 minutes and 44 seconds and she suggesting that we should wrap it up. Just a good starting conversation and then William, we want to invite you back, as this thing -

[0:35:19.3] WC: Absolutely, yeah.

[0:35:21.6] DW: A lot of collaborations going to happen, in the meantime as we get through the different phases on this that I think we’ve given people sort of an idea about what it means to talk about value and quality and where we’re trying to go collaboratively with health providers in Canada.

Starting with the pharmacists in Canada and probably moving on to some other areas of health in the years to come. So thank you William and thank you Ned.

[0:35:41.3] NP Thank you.

[0:35:41.4] WC: Okay. You’re very welcome.


[0:35:47.1] SM: Thank you to our listeners for tuning in to another episode of And Now For Something Completely Indifferent. A Canadian health benefits industry podcast.

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A s a reminder, we talk about these issues consistently in our publications which are available on our website. Specifically for today’s episode, you can check out our summer 2018 issue of Follow The Script. Thank you for listening and we’ll talk again soon.