Where do people turn to get convenient and affordable care? Their pharmacy.

Americans visit their local pharmacies daily for more than just picking up prescriptions; they also utilize these accessible locations for routine health screenings and vaccinations. Pharmacies, often regarded as  “trusted healthcare advisors” have evolved from being mere dispensaries to integral components of patient care. They are playing an active role in chronic disease management, medication adherence, and health education.

Have you ever explored what happens when payers team up with pharmacies? Together, they redefine care delivery by bringing essential health services closer to underserved communities that need them the most. This powerful partnership allows payers to expand their reach beyond traditional provider settings and reach members in regions experiencing healthcare shortages. It empowers pharmacies to support medication management, address barriers to care, and enhance member outcomes. 

Let’s uncover how collaborating with pharmacies can help payers expand care access and improve member experience and health outcomes. 

Expanding Access to Healthcare: The Role of Pharmacies in Underserved Communities

As per a report by the Joint Economic Committee, around 90% of rural areas 1 in the US face a shortage of primary care physicians. These “healthcare deserts” pose significant challenges for payers seeking equitable care for all members. However, this is where pharmacies can fill the gap. 

They can enhance care delivery to these underserved communities in the following ways:

Operating as cost-effective & accessible healthcare hubs

For payers, pharmacies are a low-cost alternative to traditional facilities. Since pharmacies have a widespread presence 2 and do not require appointments, they are more accessible to patients in underserved regions. By offering essential services such as medication management, pharmacies can reduce unnecessary hospitalizations and visits to emergency centers, bringing down healthcare costs significantly. 

Implementing targeted chronic disease management programs 

Individuals in rural areas are more likely to succumb to common chronic conditions than urban dwellers, as shown by the CDC 3 due to poor medication adherence and provider shortage.  But, through medication therapy management (MTM) and medication adherence programs like refill reminders, pharmacists ensure that patients stick to their treatment plans and avoid hospital stays. 

Ref: https://pmc.ncbi.nlm.nih.gov/articles/PMC11417871/#B3-pharmacy-12-00139 

Addressing Social Determinants of Health (SDOH) through Community Integration: Research 4 suggests that social and economic barriers to healthcare can further complicate chronic diseases, especially in underserved communities struggling with food insecurity and housing instability. 

Pharmacies, already embedded in these communities, serve as key touchpoints for essential services. From providing family planning support to prenatal care resources, they help close gaps in maternal care. They also connect those struggling with food security to nutrition assistance programs. 

Patient Convenience and Satisfaction: Enhancing Member Experience Through Pharmacy Point of Care Services

Payers can leverage the existing accessibility and patient trust in pharmacies to elevate patient experience. Pharmacies can improve the member experience by:

• Making healthcare more accessible: Long wait times at hospitals or clinics can be frustrating. Pharmacies that offer extended hours and walk-in services make it easier for patients to get minor treatments or vaccines without scheduling consultations in advance.
• Providing personalized care:  Unlike doctor visits that may feel rushed, pharmacists take the time to answer questions and explain medications to patients. This personal touch makes patients feel supported and confident in taking care of their health.Making care more connected: Pharmacies can collaborate with payers and providers to adjust medications and provide follow-up support. This coordinated approach ensures the continuity of care, improving the overall patient experience.

• Encouraging medication adherence through incentives:  Not adhering to medicines can worsen health. Pharmacies can partner with payers to introduce programs such as loyalty awards or discounts on refills for patients. Additionally, convenient options like home delivery can remove barriers to adherence, making it easier and affordable for patients to follow their plans.
• Boosting patient engagement: Pharmacies see patients more frequently than traditional providers, creating more opportunities for ongoing engagement. This gives pharmacists a chance to check in, answer common health questions, and give reminders about medications. 

How Health Plans Can Partner with Pharmacies to Extend Point of Care Services

Traditional relationships between payers and pharmacies have been transactional, often representing missed opportunities for improving outcomes and achieving higher CMS Star Ratings. Here’s how health plans can foster effective partnerships with pharmacies to expand their care delivery network and drive patient satisfaction:

Create sustainable value-based pharmacy partnerships: Staying current with health plan reimbursement policies is a challenge for many pharmacies, and they often get blinded by shifting payment rules. 

However, forward-thinking plans are creating transparent value-based arrangements that link incentives with patient outcomes. For example,  EmblemHealth is actively partnering with pharmacies to close care gaps through initiatives like A1C and blood pressure screenings at the pharmacy level. These partnerships not only expand access to preventive care, especially in underserved areas, but also reward pharmacies for their role in improving medication adherence and chronic condition management.

Also read: https://www.pharmacyquality.com/2024/10/30/the-impact-of-community-pharmacy-on-quality-care/

Leverage shared information exchange platforms to extend care delivery: Most often, pharmacists do not have access to the physician or hospital  EMR which prevents them from providing adequate comprehensive medication reviews and overall care management. 

Employing tech-enabled platforms that break down these silos is necessary to ensure seamless care coordination between payers, providers, and pharmacies. Integrating AI will also help to identify at-risk populations or those vulnerable to social determinants for timely interventions.

Embed pharmacists as members of care teams: Health plans must bring pharmacists into care teams by defining their roles clearly and setting up effective communication protocols. The Patient-Centered Medical Home (PCMH) 5  is one such framework for integrating pharmacists as part of the core healthcare team to deliver more coordinated and holistic patient care. 

Such structured frameworks allow pharmacists to develop individualized plans for their communities and interact with providers and nurses effectively. Thus, leveraging their medication expertise to improve a patient’s overall health goals.

Implement medication therapy management programs: Health plans ought to set up collaborative MTM initiatives with pharmacies that incorporate value-based incentives tied to quality outcomes. These programs should focus on high-risk groups for thorough medication reviews, all while sharing clinical data to spot opportunities for intervention. By standardizing documentation and billing processes, consistency across pharmacy networks can be maintained. 

Plus, having clear performance metrics really helps in setting achievable goals for the pharmacies involved. This approach benefits everyone. When patients stick to their treatment plans, it leads to better health outcomes, and pharmacists get to use their clinical expertise for more than just filling prescriptions, making them essential players in the healthcare team.

How Can PQS Help?

Pharmacies are quickly becoming trusted healthcare professionals, and PQS by Innovaccer enables payers to unlock their potential to enhance member outcomes. The EQUIPP^® Platform brings health plans together with over 65,000 community pharmacies to facilitate data-driven interventions at the point of care.

Moving Forward

Pharmacies are a goldmine waiting to be tapped in the world of healthcare delivery. By partnering with these trusted community hubs, health plans can boost access and achieve better health outcomes, especially in underserved areas where traditional healthcare facilities are limited. Health plans need to establish effective collaborative value-based care partnerships with pharmacies and integrate them into care plans to transform member experiences. 

Learn how your health plan can benefit from a pharmacy channel. Contact us.