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SMARTspend™ means value, quality, and patient-focused health care

October 30, 2018

Green Shield Canada (GSC) has always been focused on developing effective and innovative initiatives that provide value as well as quality. As outlined in the September issue of The Inside Story®, we have now assembled all our cost-management policies, strategies, and initiatives under the SMARTspend banner. When we describe a product or service as providing value, it means it is designed to produce a high-quality outcome relative to its costs. As a plan sponsor it’s up to you to decide how to invest in health care services that deliver the value and results you desire or require. The GSC offerings grouped under the SMARTspend umbrella are designed to directly attach value to your health benefits spend.

GSC’s Value-based Pharmacy Initiative… phase one

In late 2017, we launched phase one of Value-based Pharmacy, an initiative under the SMARTspend banner. Concentrating on quality in pharmacy care, GSC became the first payor (public or private) in Canada to measure individual pharmacy performance and provide feedback to help pharmacies gain insight into what they’re already doing well and areas where there’s room for improvement.

For about a year, we’ve been providing all pharmacies across the country with monthly scorecards that rate the pharmacy’s performance on a set of eight evidence based measures in three categories – adherence to medication therapy, chronic disease management, and patient safety. Recently, an overall score called the Pharmacy Quality Rating – indicated by one to five stars – was added to the scorecards. Like other star ratings you see, the five-star pharmacy rating reflects overall performance across all applicable quality measures: one star indicates the pharmacy performance is below average and five stars means the pharmacy’s performance is exceptional. Note that the Pharmacy Quality Rating does not include things like dispensing fees, customer service, or how quickly prescriptions are dispensed. It is about health.

phase two

On November 6, we launched phase two of this initiative: making the Pharmacy Quality Rating available to plan members to help them make an informed choice of pharmacy provider. As part of this effort, we built a brand new, modernized health provider search tool (available on GSC’s Plan Member Online Services and mobile app) that now includes information about pharmacies’ star ratings. This enables plan members to choose a pharmacy not only based on factors such as location and hours of service, but also actual quality of care delivered by that pharmacy.

We have also communicated with plan members to explain the new information available to them so they can see how their pharmacy measures up. Read the plan member communication here.

What’s next?

Eventually, in phase three of Value-based Pharmacy, GSC will tie pharmacy reimbursement to performance scores. This will ensure that pharmacies providing higher quality of care are rewarded for their efforts, while lower performing pharmacies are encouraged to improve the quality of their services. This phase is still in development but we will be sure to keep you updated as it progresses over the next six to 12 months.

Questions?

If you have any questions about Value-based Pharmacy or any SMARTspend strategies, please contact your GSC account executive.