Physician's Capitation Trend-California MD touts drug-guided capitation
Interventional pharmacy model works
Pharmacy-guided capitation payments are a practical way of getting closer to managing capitation risk, says a California physician who oversees the process in his 22-physician practice.
In a practice where about 40% of the patients are enrolled in capitation, tracking pharmacy costs has been a key to staying prosperous, says Leonard Fromer, MD, a family physician with Prairie Medical Group in Santa Monica, CA.
Fromer's practice uses an interventional pharmacy model in which pharmacy staff identify patients who are most at risk and whose drug costs could be expected to be higher than average.
For example, patients with diabetes and hypertension are prime candidates for high drug costs. The group then attempts to intervene proactively to maintain optimal health in these population groups. They include them in stepped-up educational programs and compliance monitoring with drug regimens.
A study released in September calls for "pharmacy cost groups," or PCGs, which would more precisely quantify Fromer's approach. With PCGs, patient groups would be categorized according to several clinical groups based on drug needs. Statistical weights would be assigned to these groups, and payment levels would be adjusted based on those weights.
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