Community pharmacists are pivotal players in healthcare for their ability to provide quality care and improved patient outcomes. Pharmacies are healthcare cornerstones for their neighborhoods, and they can now offer a variety of clinical services to better the health of their patients. Utilizing community pharmacies to impact quality care is a viable strategy that can benefit patients, health plans, and the healthcare system at large.
Data-driven partnerships between health plans, pharmacies, and healthcare professionals can hone in on community pharmacy engagement for improved patient outcomes.
The Evolving Role of Community Pharmacies
Pharmacies are no longer just about dispensing medications. They play a vital role in:
- Expanding access to healthcare services
- Improving medication management
- Enhancing preventative care
- Increasing patient engagement and education
EmblemHealth, a regional non-profit health plan serving approximately 2.5 million lives across New York City’s five boroughs, is integrating community pharmacies more deeply into their quality improvement strategies, viewing these local establishments not just as medication providers, but as key partners in delivering comprehensive, high-quality care.
Abdou Bah, SVP of Medical Management at EmblemHealth, adds, “We were really focusing on three critical aspects of where, from a clinical standpoint, pharmacies could play an integral part of our success… it was around obviously medication adherence and looking at ‘How do we drive adherence to key chronic conditions such as diabetes, hypertension, and cholesterol medication,’ and utilizing not only the platform and the data, to be able to present back to pharmacies.”
Data-Driven Partnerships
A key aspect of EmblemHealth’s approach is leveraging data to identify opportunities for pharmacy partnerships. They analyze:
- Geographic location of pharmacies
- Patient visit patterns
- Provider recommendations
- Adherence rates
This data-driven approach allows EmblemHealth to target specific pharmacies for enhanced partnerships and identify best practices that can be scaled across their network.
Focus Areas for Pharmacy Partnerships
What are some critical areas where pharmacies can significantly impact quality care?
- Medication Adherence: Utilizing pharmacy data to identify non-adherent patients and implement targeted interventions.
- Increased Access: Leveraging pharmacies for additional screenings, such as blood pressure and A1c tests, which can now be used as supplemental data for NCQA quality measures.
- Immunizations: Building on the success of COVID-19 vaccination efforts to expand immunization programs, particularly focusing on addressing the decline in pediatric immunizations.
EmblemHealth has found success by implementing these targeted strategies to boost medication adherence and increase screening rates. Their approach demonstrates that focused quality improvement initiatives can yield measurable results. Bah shares, “We’ve seen a direct improvement in terms of medication adherence. We’ve seen a direct improvement to our screening rate for blood pressure. So that’s a direct impact in terms of that. These strategies work. We just have to continue to build upon them and continue to think about what else can be added so that we can create a holistic, end to end value.”
The Controlling Blood Pressure (CBP) Measure
The Controlling Blood Pressure measure is becoming increasingly more important, because it is triple-weighted and critical for both preventative care and condition management. EmblemHealth’s strategy includes:
- Utilizing pharmacies as locations for blood pressure screenings
- Creating robust workflows to act on elevated readings
- Integrating pharmacy data with provider and care management programs
Bah explains, “The pharmacy can see that this member’s due for a blood pressure, and being able to not only do the screening, but also create a workflow that if it’s abnormal, sending it back to our clinical team or making a referral back to the providers.”
Immunizations and Preventative Care
Pharmacies play a central role in immunization efforts. Health plans can explore ways to partner with pharmacies for workplace and community-based flu clinics. For all vaccinations offered at a pharmacy, there is an opportunity to bundle preventative care services with immunizations. Consider coordinating outreach efforts between providers, pharmacies, and the health plan for unified messaging.
Pharmacies are encouraged to embrace partnerships with health plans for enhanced care services. Take advantage of the revenue opportunities (incentives) for quality improvement activities and take satisfaction in the impact the pharmacy team is making in community healthcare.
Challenges and Opportunities
There are challenges to building a successful value-based program such as finding the right contacts at local pharmacies, the need for standardized data collection and reporting, and the importance of aligning incentives across all stakeholders. That’s where EQUIPP can streamline this process and anchor these programs.
Abdou Bah speaks to the opportunity for all involved in healthcare, “ If you think about it today, providers are receiving incentives, members are receiving incentives, and pharmacies are now receiving incentives, and obviously the plans are receiving incentives when people are healthy and through our quality program. So again, it’s aligning all of these different levers and incentives to create true value and better health outcomes for everybody.”
Community pharmacies are poised to play an increasingly central role in quality care delivery. By fostering partnerships between health plans and pharmacies, organizations like EmblemHealth are paving the way for improved patient outcomes, increased quality scores, and a more integrated healthcare system.
As the healthcare landscape continues to evolve, the collaboration between health plans and community pharmacies will be crucial in addressing health equity, improving access to care, and ultimately driving better health outcomes for all patients.
Are you interested in learning more about community pharmacy’s willingness to participate in value-based programs like EQUIPP’s Enhanced Services? Please fill out the following form to download our latest testimonial document, “Pharmacy Partnerships: A Strategic Move for Health Plans.”
