By Udit Parikh, PharmD, MBA, Executive Resident and Mindy Smith, VP Pharmacy Practice Innovation
The Center for Medicare and Medicaid Innovation (CMMI) has been on the forefront of healthcare practice. In order to provide better quality of care and reduce costs, in 2014, they partnered with Community Care of North Carolina (CCNC) to create a program dedicated to increasing the resources for patients with the highest needs. The purpose is to analyze payment reform for the state and federal health programs.
Community Care of North Carolina applied for a grant through CMMI which resulted in the creation of the Community Pharmacy Enhanced Services Network (CPESN). “The CPESN is part of a 3-year grant funded by the CMMI to test new reimbursement models for community pharmacies serving Medicaid, Medicare, dually eligible, and NC Health Choice beneficiaries. CPESN is based on collaborative care model in which community pharmacists are active and integrated participants of the medical home care team.” (Community Care of North Carolina, 2016). Community pharmacies from North Carolina have since volunteered to collaborate, and as of December 1, 2015, there are 246 pharmacies participating. All participating pharmacies have agreed to improve quality of care and patient outcomes. Their areas of focus include:
- Medication use
- Enhancing patient health trajectory
- Reducing total cost of care
The purpose of this network was to increase the resources dedicated to patients of highest need by creating a “network of pharmacies willing to provide services and care coordination that transcend currently offered outpatient pharmacy program requirements/contracts. This includes pharmacies able to perform highly intensive, highly coordinated, and longitudinally‐oriented medication optimization activities through a method of co‐management with primary care providers, their care management teams, and the extended medical neighborhood” (Community Care of North Carolina, 2015).
The pharmacies are evaluated and reimbursed based on these areas of focus. The purpose is to analyze payment reform for the state and federal health programs. CCNC pharmacies participating in CPESN are paid for services for attributed high-risk patients which includes receiving an augmented dispensing fee of $0.58PMPM, up to $3.05PMPM for identifying, resolution and follow-up of drug therapy problems, $91 for every CMR completed and testing risk-based payment models of $5-$35. Each of these pharmacies strives to improve quality of care and patient outcomes (Branham, 2016).
Ashley Branham, PharmD, BCACP, Director of Clinical Services at Moose Pharmacy in Concord, NC explains, “these services are enhanced, longitudinal, and coordinated with the rest of the care team are not included in typical reimbursement constructs – such as medication synchronization and adherence packaging.” Furthermore, CPESN has established the importance of the collaborative care model and has urged the participating pharmacies to focus more on participating within the medical care team. As a member, they are required with providing the following services:
- Private counseling with patient in regards to medication and healthcare issues
- Establishing a professional relationship with patients
- Availability to answer questions and provide information regarding patient’s health problems
In addition to all the services, there are some optional services included in the network, such as:
- Comprehensive Medication Review (CMR)
- Home Delivery
- Medication Synchronization
- Smoking Cessation
- Point of Care testing
- Disease state Management Programs
Over the course of this program, CCNC and CMMI are evaluating the viability of expanding the collaborative care model to impact patients on a national level. Branham is lead on supporting the Multi-State recruitment and roll-out. This provides a venue to connect pharmacists and other pharmacy stakeholders who have an interest in delivering financially sustainable, patient‐centered care beyond traditional dispensing services and coalesce pharmacies based on the principle of providing value beyond selling drug product to effectuate health trajectory,” Branham continued.
Currently, CMMI is working with leader pharmacists and/or state associations to promote the CPESN in such states as, Iowa, Colorado, Tennessee, South Carolina, Arkansas, Virginia, Texas, Louisiana, and North Carolina, to name a few. They will also establish a process for various methods of communication to CPESN pharmacists via webinars, newsletters, emails, conference calls to share best practices. The next steps for Multi-State Learning Collaborative include launching a pharmacy locator app and collaboration site and release of webinars Spring and Summer Series to engage others interested in network building.
PrescribeWellness has partnered with CCNC to support clients participating in CPESN in North Carolina that are utilizing our innovative technological solutions to be successful in delivery these services. PrescribeWellness continues to drive our payer strategy to bring new funding to pharmacies for providing services. This will bring clients and members of the Multi-State High Performing Collaborative to create opportunities for pharmacists to care for patients across America and receive payments for those services. As healthcare transitions from a pill-centric to a patient-centric model, programs like this are likely to shape the future of pharmacy practice.
CCNC is inviting anyone who is interested in supporting the success of the CPESN including PSAOs, GPO’s, or vendors like PrescribeWellness to engage in any capacity they would like as there is no formal structure. If you are interested in becoming a part of CPESN, please email Ashley Branham, PharmD, BCACP Director of Clinical Services, Moose Pharmacy firstname.lastname@example.org.
- Branham, A. (2016). Community Pharmacy Enhanced Services Network The North Carolina Experience. http://www.ncpa.co/pdf/conferences/team-work-new-roles-community-pharmacy-in-the-changing-health.pdf . Fort Myer, FL: NCPA.
- Community Care of North Carolina. (2016). Community Pharmacy Enhanced Services Network (CPESN) Integrating pharmacists into the Medical Home team. Retrieved from Community Care of North Carolina: https://www.communitycarenc.org/population-management/pharmacy/community-pharmacy-enhanced-services-network-cpesn/
- Community Care of North Carolina. (2015, December 1). Community Pharmacy Enhanced Services Network: A Primer for Primary Care Providers Working with CCNC. Retrieved from Community Pharmacy Enhanced Services Network (CPESN) Integrating pharmacists into the Medical Home team: https://www.communitycarenc.org/media/related-downloads/cpesn-flyer.pdf