CMS-funded project to create community pharmacist network

Vast majority of funding to be used for payment to pharmacies for testing different payment models

Cutting costs is a key aim of health care reform. Joe Moose, PharmD, believes community pharmacists have a major role to play in reaching this goal. While prescription drugs account for only about 10% to 15% of health care spending, Moose says pharmacy’s ability to affect cost isn’t limited to drugs alone. Given the authority and reimbursed fairly, pharmacists could significantly reduce the other 85% to 90% of health care spending, Moose says.

This year, Community Care of North Carolina (CCNC) won a $15 million CMS Center for Medicare & Medicaid Innovation (CMMI) Health Care Innovation Award to demonstrate community pharmacy’s role in cutting costs. 

“This grant is about paying pharmacists for the value we bring to health care,” Moose said. “It’s about how pharmacy can do something different that capitalizes on the value we bring.”

The vast majority of funding will be used for payment to pharmacies for testing different payment models. This is a network created to overlay with the workflow of a busy community pharmacy and reimburse pharmacies enough to get meaningful outcomes for health care at a price they can afford.

CMMI Health Care Innovation Award

CCNC was among 39 recipients of the second round of CMMI Health Care Innovation Awards announced in May and July of this year. This round of 3-year awards went to private and public organizations that “have a high likelihood of driving health care system transformation and delivering better outcomes,” according to CMS.

CCNC is a physician-led community organization that contracts with the state to care for the vast majority of North Carolina’s Medicaid patients. Partnering with and sharing information with hospitals, ambulatory clinics, and health care providers across disciplines including pharmacy, plus caseworkers, CCNC coordinates care for the state’s most vulnerable patients.  Moose saw an opportunity for care coordination that CCNC was missing.

“The missing piece is connectivity with community pharmacy,” Moose said. “The Medicaid population in North Carolina sees their primary care doctor about three times a year. They see other health care providers between 6 and 9 times a year, but they see their community pharmacist 35 times a year. So this is 35 opportunities we have to help reinforce that care plan.”

CCNC’s standard protocol is to devise a care plan with patients after they are discharged from the hospital and engage community partners and home visits to help enforce that plan.

Patients reap benefits

Now community pharmacists will be among those partners. CCNC’s Community Pharmacy Enhanced Services Network will create a network of community pharmacists across the state and provide them with the technology to communicate and share information with members of CCNC’s multidisciplinary care teams.

The network currently includes 72 pharmacies in 26 counties across the state. The pharmacies will provide CCNC patients with counseling and adherence coaching and medication reconciliation among other services.

Patients already are reaping the benefits. Recently, CCNC referred a patient to a pharmacy in the network. The patient was 61 years old, had been to the emergency department (ED) repeatedly, and had multiple unfilled prescriptions for inhalers, but CCNC caseworkers had not been able to reach him. Now that the pharmacy had access to the providers’ names and the patient’s medication list, a pharmacist could perform medication reconciliation and continue trying to contact the patient.

“At the pharmacy follow-up the next month, the patient reported using his inhaler and having an improved quality of life, explaining that he could now walk around the cul-de-sac and not feel breathless,” Moose said.

Demonstrating ROI

Interventions like these won’t necessarily decrease drug spending. Before the community pharmacist reached the patient, he wasn’t spending any money on medications because he wasn’t getting his prescriptions filled. But as long as he wasn’t taking his medication, he was returning to the ED, which is far more expensive than an inhaler.

“You may have to spend a little more money up front, but you get a lot more in return,” Moose said. “And we may be able to realize that return pretty quickly. With certain populations, you can cut them down one ED visit more, and you’ve got your immediate return.”

The 3-year pilot project will culminate in a paper in which CCNC hopes to demonstrate the return on investment (ROI) that community pharmacy can bring.