Elevance Health PPI Report

Here’s what we know: High-touch medication-use and whole health services provided by local pharmacists will help patients meet their health goals. This effort leads to improved quality ratings, trusted patient care, and a healthier bottom line for both pharmacies and public and private payers of that care.

Here is the struggle: 1) Raising awareness of what local, independent pharmacies can do and 2) sharing data with enough scale to impact change.

CPESN USA recently hosted its local network leadership teams during the annual leadership event outside Charlotte, N.C. The keynote speaker was Marcus Wilson, Pharm D., Elevance Health’s Chief Analytics Officer, and a trained clinical pharmacist. In this role, Dr. Wilson is responsible for developing and executing an enterprise-wide analytics strategy that spans across financial, clinical, and provider analytics for Elevance Health and oversees the organization's clinical data access and interoperability program. During the keynote session, Dr. Wilson shared his insights on the value that bi-directional data flow has toward providing actionable, patient-level insights. 

Since 2021, Elevance Health and CPESN USA have embarked on a multi-network, multi-state collaboration to improve the health of millions of Americans. Elevance Health’s pharmacy benefit manager, CarelonRx, collaborates with patients’ independent, community-based pharmacists who can then intervene with patients on a local level. Elevance Health shared some of the early success of the collaboration in a recent white paper. That success included an overall reduction in medical services utilization and costs due to an approximate 30% reduction in inpatient admissions and 18% reduction in Emergency Department (ED) utilization.

Results from a separate Elevance Health and CPESN program also yielded data that warrants sharing. 41% of identified high-risk patients that received care from a CPESN-affiliated pharmacy achieved increased medication adherence up to 23%, including an 8% reduction in inpatient hospitalizations and a 13% reduction in ED visits.

The Elevance Health/CarelonRx and CPESN network collaboration continues in 11 different states currently and 14 states expected by 2025.

Speaking of the value of data, CPESN USA was recently recognized with the 2024 SAS Customer Recognition Award in the Community Uplift Category, awarded to a SAS customer who has made an impact in their community at large using SAS products.

During the COVID pandemic, CPESN USA was selected by the Centers for Disease Control and Prevention (CDC) as one of the Federal Retail Pharmacy Partners to administer COVID vaccines via local pharmacies. The challenge for our team was to ingest vaccine administration data that we received from 2,000 individual businesses (our CPESN pharmacies), create reports in a specific template provided by the CDC, and upload those reports to the CDC portal on daily basis. The efforts made by the CPESN USA data team were reflected in CDC’s validation score card, where CPESN USA achieved 10 out of 10 on all data quality metrics.

Since CPESN USA was able to receive and report vaccine administration data, local independent pharmacies were able to participate in the CDC’s program. Without it, they wouldn’t be able to access the federal allocation of vaccine. The program closed at the end of 2023, and 2,000 (out of 3,500) CPESN participating pharmacies received 7 million doses of vaccine and administered nearly 6.8 million vaccinations. Combined efforts earned the pharmacies $270M in additional revenue AND helped make a healthier patient population within the local community.

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