Patient Driven Payment Model

Patient Driven Payment Model
(PDPM) Program

Our PDPM program arms providers with the actionable tools and guidance to succeed under the PDPM. From facility education, like cheat sheets and in-services, to on-site consultation and MDS data collection resources and audits, we’re improving facilities’ business processes to optimize care and reimbursement in this new environment. Components of the program include:

Clinical Expertise

Since accurately recording residents’ diagnoses and specific medical issues is vital to compensation, our consultant pharmacists play a key role in identifying the correct patient- centered care that will reward providers as well as optimize medication therapy for medically complex patients.

Cost Optimization

While much of the focus of the PDPM is on the revenue side, there is much to gain on the expense side by focusing on improved pharmacy cost management. PharMerica offers proven cost containment tools, including:

    • A quantity limit program that lowers cost by setting dispensing limits for specific medications typically used in short-stay conditions or where smaller packaging is available. With the current length of stay expected to drop from the current average of 23 days, this program reduces facilities’ exposure to high-cost medications for shorter stays that will result from rate tapering


  • Therapeutic interchange and global authorization through a dispensing system module that immediately identifies cost-saving opportunities at the point of order for Medicare Part A and managed care patients. The less expensive alternatives are clinically efficacious and reviewed clinically by a third-party drug information center as well as PharMerica’s Pharmacy and Therapeutics Committee

Staff Education

While the PDPM improves services for medically complex residents, facilities need to provide the right level of care to each resident. PharMerica can help by providing training and education through PharMerica University, which provides a range of accredited, continuing education programs online or on site.

Disease-State Management

To reduce healthcare costs and improve quality of life for patients with complex, chronic conditions who are more attractive under the PDPM, PharMerica’s subject matter experts provide information to assist in developing protocols and pathways, from guides on how to clean an inhaler to optimizing COPD, diabetes, or HIV medication therapy.

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