Author Contributions (CRediT)

Amanda Harrington: conceptualization, methodology, formal analysis, investigation, data curation, writing – original draft, visualization, project administration, funding acquisition; Shannon Vaffis: validation, data curation, writing – original draft, writing – review and editing, visualization; William Doucette: validation, writing – review and editing; Sandipan Bhattacharjee: validation, writing – review and editing; Chris Chan: resources, supervision, project administration, funding acquisition; Daniel Malone: methodology, validation, writing – review and editing; and Terri Warholak: conceptualization, methodology, validation, data curation, writing – review and editing, supervision, funding acquisition.

Funding Support

Funding: No funding was received for this research or the publication of this manuscript.

Disclosures of Conflicts of Interest

The authors declare no relevant conflicts of interest or financial relationships.

Previous Presentations of the Work

This work has not been published nor has it been submitted simultaneously for publication elsewhere.

Practice Points

• In the design of the financial incentive, the size, nature (reward vs. penalty), and implementation (e.g., directed at a pharmacy organization vs. pharmacist) should be examined.

• In the selection of healthcare performance measures to use in a value-based program, measure aspects should be considered, including: balance between measure simplicity and comprehensiveness; number of measures assessed relative to the required number to adequately assess performance; scope of the measure (targeted vs. global); satisfaction of the measure’s face validity to the provider; and the provider’s perceived and actualized ability to impact the performance measure.

What Was Already Known

• Previous research has been performed to establish conceptual frameworks and evaluate the effect of fee-for-service pharmacist reimbursement for pharmaceutical care services (i.e., non-dispensing), however, pharmacy pay-for-performance programs have not been evaluated.

What This Study Adds

• As more health plans initiate pharmacy P4P programs, there exists a need to define factors that should be considered for inclusion in analytic assessments of these financial incentive programs.

• The proposed theory-derived conceptual framework serves to depict how the integration of P4P and other factors may affect the pharmacy environment and subsequently impact a pharmacy’s capability to perform well on medication-related quality measures.

• This framework may be used as a foundation upon which to design studies to investigate the association between community pharmacy factors and performance in a P4P program.