Payer Solutions

CPESN® pharmacies are clinically integrated, performance based, and willing to be held accountable.

Value contracting is made easy for Payers, Partners, and Purchasers with a single agreement covering 48 networks of more than 3,500 independent community pharmacies in 45 states. Download our Value-Based Contracting Framework here.

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Amina Abubakar, Pharmacist/Owner, Avant Pharmacy and Wellness - CPESN® North Carolina Luminary

Amina Abubakar

Pharmacist/Owner, Avant Pharmacy and Wellness - CPESN® North Carolina Luminary

Clinical Services
Clinical Services

CPESN USA EngageRx® Delivers Results for Payers, and Patients

Download EngageRx Evidence PDF

CPESN is a true pharmacy provider network with deep community ties and local relationships that allow our pharmacies to reach and engage patients for results. Here are a just a few examples of how CPESN pharmacies work with payers to improve patient outcomes while helping lower overall healthcare costs:

  • Regional ACO and a local health system collaborated with a local network and realized 30% gap closure in just two weeks
  • Local network program with a Medicaid Managed Care Organization showed 18% reduction in overall Emergency Department costs with members utilizing CPESN pharmacies
  • Local network program showed a statistically significant reduction in both systolic and diastolic blood pressure. At baseline 26.9% of patients had controlled BP as compared to 56.3% patients at follow up
  • Medicaid MCO collaborated with a local network and 82% of its members achieved the goal HEDIS® measure
  • Local network program with a Duals plan closed 10% of care gaps in Controlling Blood Pressure Program in just one month

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CPESN Pharmacies Provide Enhanced Patient Care Services 

CSEPN Flow Chart
CSEPN Flow Chart

Enhanced health services delivered locally

Blood Pressure Monitoring
Blood Pressure Monitoring

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CPESN pharmacies collaborate with other health providers to help payers meet quality goals by identifying and closing care gaps. Building on trust and local relationships, they engage the unreachable with pharmacist-led clinical interventions that:

  • Lower blood pressure
  • Lower HgA1C
  • Decrease ER visits and hospitalizations 
  • Lower the total cost of care
  • Improve health awareness through education
  • Improve employee productivity

Download EngageRx HEDIS Gaps PDF   

Download EngageRx STAR Plan Measures PDF
 

Solutions for Payers

Commerical insurers
Commerical Insurers

CPESN pharmacies provide individualized health services to commercial insurance plan members with a focus on keeping patients healthy and out of the hospital.

Medicaid
Medicaid

Medicaid programs in a growing number of states rely on CPESN pharmacies to reach patients managing challenging health issues. CPESN pharmacies focus on decreasing the cost of care, one patient at a time through increased access to effective care and health-risk reduction programs. For example, pharmacy services have increased medication adherence for behavioral health patients, resulting in improved overall health. 

Managed Care Organizations
Managed Care Organizations (MCOs)

CPESN pharmacies support Medicaid MCOs by assisting with HEDIS gap closures including Asthma Medication Ration (AMR), Controlling High Blood Pressure (CBP), Statin Therapy for Patients with Diabetes (SPD), Hemoglobin A1c Control for Patients with Diabetes (HBD), and more. Pharmacies are also a point of connection for patients to be referred to plan resources and/or primary care when needed. 

Medicare
Medicare

CPESN pharmacies focus on quality and reduction in total cost of care through high-touch patient care services. CPESN pharmacists work with Medicare plans across the country to improve medication utilization through adherence programs, medication therapy management services, and management of patients with chronic conditions.

Solutions for Partners

Healthcare Systems
Healthcare Systems

CPESN pharmacies work with health systems to provide transitions-of-care support through medication reconciliation services, and ongoing pharmacy support such as adherence packaging and home delivery. Ongoing patient monitoring services, data sharing, and collaboration with the full health team improves patient outcomes.

ACOs
ACOs

CPESN pharmacies are uniquely positioned to assist practices in value-based care models in achieving success in medication-related quality measures, including STAR ratings. Services delivered in partnership with ACOs include medication compliance, medication synchronization, adherence packaging, and cost containment recommendations.

Physician Practices
Physician Practices

Building on trusted community alliances with physicians, CPESN pharmacists integrate clinical services to medical practices including chronic care management, diabetes education and support, disease screenings, annual wellness visits, and medication reviews.

Grant-Funded Programs & Demonstration Projects
Grant-Funded Programs & Demonstration Projects

Grant funding in partnership with state health departments and CPESN local networks support pharmacist services in health population management and disease risk intervention programs.

Solutions for Purchasers

Medicare

Medicare

CPESN pharmacies participate in value-based care models to achieve success in medication-related quality measures, including STAR ratings. CPESN pharmacists provide comprehensive medication reviews and medication reconciliation services at transitions of care to reduce readmissions.

Self-Insured Employers

Self-Insured Employers

CPESN pharmacies work directly with self-insured employers to deliver chronic disease screening, education, and prevention programs that result in increased employee productivity, lower absenteeism, decreased hospital and ER visits, and overall lower cost of care.

Health Departments

Health Departments

Through partnership programs with state health departments, CPESN community-based pharmacies are recognized as valuable partners in chronic disease management.

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EngageRx
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WeCarePlan for Patients
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An Investment Not a Cost Center
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CPESN Expect More
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