Investment in MTM services a win for Giant Eagle, patients, and payers
Many health care plans now contract with the chain directly
Giant Eagle is a medium-sized chain, but when it comes to providing MTM services, it’s a titan. Its clinical program has racked up awards from health plans, vendors, and pharmacy organizations—including APhA—and continues to expand. What’s the secret to its success? Corporate support, a dedicated team of pharmacists and pharmacy technicians, and a healthy dose of competitive spirit.
“I remember sitting in a conference room with our CEO [Laura Karet] and talking about star ratings,” said Debbie Krasnow, PharmD, senior director of managed care at Giant Eagle. Star ratings help beneficiaries compare Medicare Advantage and Part D plans on the basis of quality, cost, and coverage.
“[Karet] said to me, ‘I want to be five stars,’” Krasnow said. “It’s unusual for a CEO of a supermarket chain to be that invested in a program like this.”
In 2013, the chain began efforts to make its MTM services more robust. Pharmacist clinical coordinators traveled from store to store, training pharmacists and technicians to perform MTM interventions such as comprehensive and targeted medication reviews. Health plans and vendors like OutcomesMTM would identify patients who qualified for the services.
According to John DeJames, RPh, senior manager of clinical programs at Giant Eagle, the leaders of the year-old program felt confident enough to participate in United Healthcare’s Targeted Intervention Program (TIP) Challenge in 2013.
“We’re a regional chain, and we were going up against national players,” DeJames said. “Around Thanksgiving they gave us a call and said, ‘Guess what? You guys are number one.’”
The win bolstered support for the program. “In 2014, the goal was to get one ‘clinical point person’ trained and able to do these interventions at every store,” said Chad Bahl, PharmD, clinical pharmacy district leader for Ohio. The next year, the chain aimed to train every pharmacist to ensure patients could receive services no matter who was on duty at the time.
Accolades came rolling in. Giant Eagle won the United Healthcare TIP challenge again in 2014 and 2015. OutcomesMTM named it the top medium-chain MTM provider in 2015 and 2016 and is trending to be the top performer in 2017.
“Our team is competitive and passionate about patient care,” Krasnow said. “How you performed last year isn’t good enough this year.”
Many health care plans now contract with Giant Eagle directly instead of going through vendors, and the chain has added a clinical call center to support its growing operations.
“Health plans will say, ‘We have call centers, why would yours be any better,” Krasnow said. “But the patient is more receptive when their Giant Eagle pharmacist calls.”
The chain worked immunizations into the program. “Our numbers are through the roof. Even though the market’s been pretty stagnant with flu, we’ve had double-digit increases the last few years,” DeJames said. Giant Eagle was honored as an APhA Immunization Champion in 2015.
Locations of the chain in western Pennsylvania, which serve a large Medicaid population, are expanding services—and adopting a reimbursement structure—through participation in the Pennsylvania Pharmacy Care Network.
“The managed Medicaid patients are used to having to stand in line and go to clinics,” Krasnow said. “We have pharmacists reaching out to them to say, ‘Can you come in to talk about your medication?’ It’s refreshing.”
Giant Eagle also offers residencies and has staff teaching part-time at local pharmacy schools. “Being onsite at the university level and allowing students to work alongside us is an opportunity to give back,” Bahl said.
For the full article, visit www.pharmacytoday.org for the upcoming January 2018 issue of Pharmacy Today.