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Fight DIR Fees This Fall: Proven Tactics to Use During Open Enrollment

Posted on November 11, 2020 by Amplicare Team

Do you feel in the dark about DIR fees? You’re not alone. DIR fees can mystify even the best pharmacists. 

It can be challenging to incorporate the various fee schedules and rates into your cost calculations when you don’t have visibility into how they’re charged or what might affect them.

Multiply that challenge by all the different plans your patients have and the sheer number of patients you care for - the result is likely a huge headache.

As a patient-care-oriented pharmacist, you’re not just worried about your financials. You also want to make sure your patients get the coverage they deserve - for the most affordable price possible.

This Medicare Open Enrollment period, learn how Amplicare can help you automate the most effective DIR mitigation strategies to save time on administrative work, allowing you to focus on providing the best patient care possible.

Fighting DIR Fees Round 1: Navigating plan selection

1. Take control of DIR fees by recommending patient plans based on your store’s performance

DIR fees can feel like they’re out of your control - and sometimes they are. Some plans calculate DIR fees according to the performance of pharmacies in your network (PSAO-performance-based fees). Imagine getting graded at school based on how other students in your class did - it’s definitely not optimal.

You can start to take back control by finding plans that will save your patients money because they’re based on your individual pharmacy’s performance (which you have control over) instead of your network’s performance as a whole (which you don’t).

Doing this will open new doors for your pharmacy as your patients’ plans will start to reward actions you take by reducing DIR fees; it’s that easy.

2. Guide patients towards plans based on their needs and adherence

DIR fees are often determined by medication adherence, i.e., making sure your patients refill and pick-up their prescriptions.

The idea is simple: if a patient is highly adherent, a plan that rewards high adherence is optimal. If they’re not very adherent, you can identify plans that don't penalize you for it without compromising quality of care so you both can save (and always work to improve adherence, of course!)

As a busy pharmacist, this may sound like a lot of work. Luckily, Amplicare can do the heavy-lifting for you. With our automated reports, you can get insight into every patient’s adherence level and compare plans for them accordingly.

3. Identify cost-saving actions you and your patients can take

While you’re attending to your patients, our platform automatically identifies cost-saving actions for you.

From navigating available plans to help your patients find the best options to discovering DIR fees often buried deep in contracts, Amplicare’s reporting toolkit has everything you need to make the most of this Medicare Open Enrollment period

With Amplicare, you’ll also find tools to review medication costs, doctor networks, drug coverages, and identify high-value patients, all with just a few clicks.

Fighting DIR Fees Round 2: Boosting your pharmacy’s performance

1. Strengthen your pharmacy’s performance metrics (not Star Rating)

To further fight DIR fees, you should focus on your pharmacy’s performance metrics, not your Star Rating.

This is often confusing, we know, but “performance metrics” and “Star Ratings” are actually two different systems.

While becoming a five-star pharmacy is great news and offers its own benefits, it won’t necessarily help you slash your DIR fees.

Let’s dive deeper into proven tactics for strengthening your pharmacy’s performance.

2. Prioritize outliers and dual-eligible patients for high gains 

You’ve got your hands full during Medicare Open Enrollment, which is why you should focus on certain high-value groups.

Be on the lookout for your outliers: those patients who aren’t adherent to their medications, especially for hypertension, statin, or cholesterol. 

Since this group is weighted heavily in DIR fees, you’ll want to focus your outreach efforts on them - reminding them of the importance of regularly taking their medications, sending refill reminders, perhaps even giving them a friendly check-up call to address any concerns they might have.

In doing all this, you’ll probably find you’ve also improved patient satisfaction along the way.

Dual-eligible patients — those who qualify for both Medicare and Medicaid benefits — are another group to focus on. They have a lot of flexibility to switch plans (they’re one of the few groups who can switch outside of the standard Open Enrollment period), which you can leverage year round but especially during Medicare Open Enrollment to help them find the plan that best fits their needs and budget.

Fun fact: Amplicare can help you identify dual-eligible patients and top plans according to their medications.

3. Get to the heart of low adherence by addressing nutrient depletion

Why do patients stop taking their medications?

It’s impossible to know if you don’t reach out and ask them.

You may be able to help more than you realize, as most patients stop taking their medications after suffering from negative side effects. As a way to help combat this, you can suggest supplements or alternative treatments to mitigate these unwanted effects.

Not sure which supplements to recommend for which patients? Check out our Supplements Guide for Pharmacists to learn more.

4. Use Amplicare’s digital communication tools for patient outreach

Especially during the COVID-19 pandemic, digital outreach has proven an invaluable tactic for helping your patients navigate Medicare Open Enrollment from a safe distance.

Through our platform, you can safely and securely save plan comparisons for your patients for them to review from the comfort of their homes, as well as reminders for Medicare Open Enrollment deadlines.

And digital outreach goes beyond the Open Enrollment period. All year round, you can send refill reminders, schedule personalized calls, and connect digitally with your patients through our platform.

5. Make the most of Amplicare reports for actionable insights 

Amplicare was built from the ground up by pharmacists like you to put actionable insights at your fingertips.

Inside our platform, you’ll find reports for all your patients’ needs, including the “Win-Win Report,” which identifies cost-savings for you and your patients that don’t require any sacrifices in care quality. 

How does this work?

Essentially, Amplicare searches through your thousands of patients and available plans to identify high-gain care scenarios where you and your patients can save without any meaningful changes in their coverage.

Your patients will save, your pharmacy will save, and you’ll strengthen your pharmacy-patient relationship in the long run.

Fighting DIR Fees Round 3: Get even more actionable insights in our Ultimate Guide

Fighting DIR fees with the proven tactics for navigating plan selection and boosting your pharmacy’s performance covered in our new guide is a great start.

With Amplicare, you can get actionable insights that enhance the quality of care for your patients along with saving you time, money, and stress during Medicare Open Enrollment.

Interested in getting even more details about DIR fees and how you can fight them this fall? Then download our ultimate DIR Fees Guide below and make this Open Enrollment period a success!

[Lower Your DIR Fees]


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