Sunflower Health Plan CPPA Accreditation How To Guide
Sunflower Health Plan strives to improve health outcomes for patients through member access to high quality patient care services from pharmacists. Sunflower Health Plan is the first plan in the nation to create an innovative incentive for network pharmacy practices to become accredited by the Center for Pharmacy Practice Accreditation (CPPA). Sunflower Health Plan network pharmacy providers in Kansas that are accredited by CPPA will receive an enhanced professional fee of an additional $0.50 on every claim paid to the pharmacy effective April 1, 2016.
The Center for Pharmacy Practice Accreditation (CPPA) is a nonprofit organization established through a partnership of the American Pharmacists Association (APhA), the National Association of Boards of Pharmacy (NABP), and the American Society of Health-System Pharmacists (ASHP) to recognize pharmacy practices for providing patient care services that improve health outcomes and contribute to lower health care costs. CPPA develops and implements comprehensive programs of pharmacy practice site accreditation and manages the process leading to the use of consensus-based standards for pharmacy practice accreditation. Currently, CPPA offers accreditation for Community Pharmacy Practice, Specialty Pharmacy Practice, and Telehealth Pharmacy Practice. For additional information about CPPA and its accreditation programs, visit http://pharmacypracticeaccredit.org.
CPPA accreditation requires pharmacies to demonstrate proficiencies in areas of pharmacy practice that align with Sunflower’s vision of obtaining the highest quality healthcare services for its members. Advantages of CPPA accreditation include:
- CPPA’s accreditation programs are developed by pharmacists for pharmacies. The consensus-based practice standards driving the accreditation process were developed by professionals who have strong medication-use knowledge and experience with the medication-use process.
- CPPA publishes their accreditation standards, including a detailed narrative describing expectations for the practice to achieve accreditation.
- CPPA’s mission, which is unique among accreditors, is to raise the level of pharmacy-delivered patient care services through accreditation. To help achieve its mission, CPPA’s accreditation programs are consultative in nature, where the accreditation body shares best practices with the applicant in order to promote innovation and empower pharmacists to elevate the level of practice.
The process for CPPA accreditation is transparent and CPPA staff provide guidance to the applicant to successfully navigate the process. The accreditation process involves the following steps:
- Applicant submits an application and payment.
- In general, the time to complete the application is less than one hour. Application materials can be found at the following links.
- Applicant completes the CPPA Document Assessment Checklist.
- The Document Assessment Checklist is a tool to assist the applicant in collecting and organizing policies and procedures and documentation to demonstrate compliance with the standards.
- The Document Assessment Checklist and submission of documentation must be completed by the applicant within 90 days of receipt and will be reviewed by CPPA staff within 3-4 weeks after submission.
- Once the document assessment is complete and verified by CPPA staff, the applicant is notified of survey eligibility and provided with information about the on-site survey process.
- Applicant site survey is completed.
- An unannounced survey generally occurs within 6 weeks of survey eligibility notification.
- Within four to six weeks following the survey, the applicant will receive a post-survey letter stating their site survey is complete or there are items that are non-compliant or require clarification by the pharmacy practice. If there are outstanding items to address, the letter will include a request for a plan of action and a designated timeline. The plan of action from the applicant is due within 30 days.
- When the plan of action is received, and all outstanding items from the site survey are addressed, the accreditation report will be reviewed by the CPPA Accreditation Oversight Committee.
- Accreditation Status is determined.
- The CPPA Accreditation Oversight Committee meets quarterly to review accreditation reports and recommend to the Board of Directors accreditation status for the applicants.
- The CPPA Executive Director will notify the applicant of the accreditation decision.
For more information about the CPPA accreditation process, including the standards, a self-assessment tool, and application materials, applicants can visit www.pharmacypracticeaccredit.org.
In general, the accreditation process takes from six to nine months depending on the preparation and responsiveness of the applicant. Accreditation is for three years.
Applicants can contact CPPA at email@example.com to request a pricing proposal for accreditation. Pricing methodology is based on the size and structure of the organization requesting accreditation.
As an example, let’s calculate the return on investment for a Sunflower Health Plan network pharmacy provider that successfully achieves CPPA Community Pharmacy Practice Accreditation for a single site community pharmacy practice.
- The cost of the 3-year Community Pharmacy Practice Accreditation for a single site community pharmacy practice is $3,250.
- The CPPA Accredited pharmacy receives an enhanced professional fee of $0.50 for every pharmacy claim.
- If the pharmacy files 6,500 pharmacy claims over the 3-year accreditation period, which is less than 6 pharmacy claims per day, they will recover their investment.
As the healthcare industry is evolving and new models of care focus on the effective use of resources to deliver quality health care and improve patient outcomes, accreditation provides pharmacy practices an opportunity to demonstrate the value their pharmacists, staff, and services provide to the patients they serve in a predictable and measurable way.
Payers, patients, and providers that choose a pharmacy that has earned CPPA accreditation can conclude the following:
- The pharmacy provides an advanced and consistent level of patient care services for a superior health care value.
- The pharmacy evaluates outcomes and metrics to assess the effectiveness and quality of patient care services to ensure their programs contribute to improving the health outcomes of the public.
- The pharmacy is committed to continuous quality improvement.
Once your pharmacy is accredited by CPPA, please contact Envolve Pharmacy Solutions at: pharmacynetworkteam@EnvolveHealth.com to start receiving the enhanced professional fee for Sunflower Health Plan pharmacy claims.