Influence of a financial incentive on cognitive services: CARE project design/implementation

Area of Science:

• Health Services Research
• Pharmacy Practice
• Health Economics

Background:

• Community pharmacies provide essential cognitive services (CS) to patients.
• Reimbursement for these services is crucial for sustainability and patient care.
• The Washington State Cognitive Activities and Reimbursement Effectiveness (CARE) Project aimed to address this by testing a payment model.

Purpose of the Study:

• To describe the design and methods of the CARE Project.
• To evaluate the project's objectives regarding cognitive service reimbursement.
• To assess the achievement of implementation goals for community pharmacies serving Medicaid patients.

Main Methods:

• Prospective randomized trial involving 200 community pharmacies in Washington State.
• Pharmacies were assigned to documentation-and-payment, documentation-only, or control groups.
• A problem-intervention-result classification system within a pseudo-National Drug Code format was used for documenting CS.

Main Results:

• Over 20,240 cognitive service records were documented by pharmacists.
• Approximately 89% of records passed initial edit checks, with 94% passing after modification.
• The developed coding system proved sufficient for documenting interventions, with minor revisions.

Conclusions:

• A system for documenting and reimbursing pharmacists' cognitive services for Medicaid recipients was successfully implemented in community pharmacies.
• The implementation was relatively straightforward, indicating the potential for broader adoption.
• The project demonstrated the feasibility of integrating payment for cognitive services into existing pharmacy operations.