Leveraging Pharmacies to Close Clinical Care Gaps: A Health Plan Perspective

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To improve patient outcomes and reduce healthcare costs, health plan payers are seeking innovative strategies and resources across the entire healthcare industry. Community pharmacy is one healthcare sector that is now being recognized as a popular access point of care by members. By leveraging the expertise and accessibility of pharmacists, health plans can significantly impact the management of chronic conditions and close critical care gaps.

The Challenge: Uncontrolled Chronic Conditions

• Chronic conditions like diabetes and hypertension pose significant and costly challenges to our healthcare system. They can significantly impact a person’s health and often go unchecked. A closer look at the numbers show:
• More than 38 million Americans have diabetes and 1 in 5 don’t know they have it. Screenings for prediabetes and type 2 diabetes recommendations were lowered from all adults age 45 and older down to all adults age 35 and older in 2022.¹
  Hypertension affects nearly half of adults (119.9 million) and only an estimated 25% of these adults (27 million) have blood pressure under control.²

Millions of patients need help managing these conditions and navigating a complex healthcare system. This is where pharmacies can step in and play a vital role in helping health plans document these disease states.

The Solution: Pharmacy-Based Interventions

Pharmacies offer a unique opportunity to address these challenges:

• Accessibility: Pharmacists are often the most accessible healthcare professionals, with frequent patient interactions.
• Expertise: Pharmacists are medication experts, capable of identifying drug interactions and optimizing treatment plans.
• Trust: As trusted community figures, pharmacists can effectively engage patients in their health management.

Evidence Based Impact: Closing the Gap on Blood Pressure and Blood Sugar Control

A recent American Heart Association Cardiovascular Quality and Outcomes research article, “Role of Health Care Professionals in the Success of Blood Pressure Control Interventions in Patients With Hypertension” shows that pharmacist-led interventions resulted in the greatest systolic and diastolic BP reductions when compared with other health care professionals.³

Research shows that pharmacy interventions can significantly improve patient outcomes. Pharmacists can:

• Educate patients about their medications, healthy lifestyle choices, and how to properly manage their condition.
• Monitor blood pressure and blood sugar levels to identify potential issues early on.
• Review medication regimens to identify potential interactions or gaps in treatment.
• Work with physicians to recommend medication adjustments or address medication adherence concerns.

Collaboration is Key: Pharmacists, Physicians, and Health Plans Working Together

The benefits of teamwork are clear. When pharmacists and physicians collaborate, patients receive more comprehensive and coordinated care. Health plans can incentivize pharmacists for primary care services that benefit the community pharmacy and improve the health of the patient. This collaboration can lead to:

• Improved blood pressure and blood sugar control
• Reduced risk of complications associated with chronic conditions
• Enhanced patient understanding of their condition and medications

Medication Safety: Your Pharmacist’s Expertise

Pharmacists are medication safety experts. They are trained to identify potential drug interactions and ensure patients receive the most appropriate medications for their individual needs. This expertise is crucial in closing care gaps and providing the best possible support for patients managing chronic conditions.

The Financial Case for Health Plans

Investing in pharmacy partnerships can lead to significant cost savings:

• Reduced hospital admissions and readmissions due to better chronic disease management
• Lower medication costs through improved adherence and optimized treatment plans
• Decreased emergency department visits for manageable conditions

Implementation Strategies for Health Plans

As trusted healthcare professionals in the community, pharmacists are powerful allies in managing chronic conditions like hypertension and diabetes. They can take blood pressure checks and HbA1c screenings and document these numbers. Pharmacists can also provide immediate recommendations to the patient, post screening. So, what are some implementation strategies available for health plans?

• Incentivize Pharmacy Services: Develop reimbursement models that reward pharmacies for providing clinical services and achieving health outcomes.
• Data Integration: Implement systems to seamlessly share patient data between pharmacies and other healthcare providers.
• Collaborative Care Models: Establish formal collaborations between pharmacists, physicians, and other healthcare professionals.
• Patient Engagement: Educate plan members about the expanded services available at their local pharmacies.
  Quality Metrics: Incorporate pharmacy-based interventions into your quality improvement initiatives and performance metrics.

Pharmacies represent a fresh resource in our efforts to close clinical care gaps and improve population health. By leveraging the accessibility, expertise, and community presence of pharmacists, health plans can enhance chronic disease management, improve patient outcomes, and ultimately reduce healthcare costs.

As we move towards a more integrated and patient-centered healthcare system, partnerships with community pharmacies will be crucial in achieving our goals of better health outcomes and more efficient healthcare delivery.

To learn more about how your health plan can leverage pharmacy partnerships to close care gaps and improve outcomes, download our free PQS by Innovaccer brochure: PQS Brochure for Health Plans by filling out the form below.

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