Success Stories

Watch this short video to learn more about how CPESN USA's 3,500 pharmacies and 8,000 providers help health plans lower cost, while improving patient health outcomes. And see examples how payer programs are generating revenue for our pharmacies. Pharmacy owners collaborating with other pharmacy owners to generate new revenue streams.

Increased pharmacy engagement with a Medicaid MCO population is the goal for CPESN® North Carolina pharmacies participating in a renewed diabetes management program. Clinical services being provided under the contract med sync and other efforts to increase adherence, as well as regular monitoring of glucose levels. Laura Rhodes, Managing Network Facilitator, hopes the deeper patient engagement and refreshed data will lead to another renewal for 2025.

Dayna Wong-Otis, CPESN® Hawaii Managing Network Facilitator, describes the network's newest payer program with MDX Hawaii. Pharmacies on three of the Hawaiian islands will work with patients enrolled in Medicare Advantage programs to help close adherence gaps associated with STAR measures. The payer has already expressed interest in additional pharmacy services.

Patient trust allows community pharmacists in Tennessee's two networks to complete Health Risk Assessments with UnitedHealthcare's hard-to-reach members. Amber Suthers, CPESN Tennessee, Managing Network Facilitator, says it's rewarding to see payers recognize community pharmacy's value in caring for patients. The program is open to all CPESN Tennessee and CPESN Northeast Tennessee pharmacies.

Inpatient admissions were 33% points lower for high-risk Medicaid patients engaged with CPESN community pharmacists during a pilot outreach program, compared with those members not reached by local pharmacists. Results of the claims data lookback study are reported in research released by the Elevance Health Public Policy Institute. Lindsey Ludwig, CPESN Iowa Executive Director, describes the impact of the two-year program in this short video. Elevance Health/CarelonRx currently has programs in 11 CPESN networks with plans to add more this year.

Strong performance by CPESN Minnesota pharmacies statewide led to an expanded UCare Minnesota contract. The gap closure program has been expanded to 16 areas of care, including five care coordination measures.

The Corporation for Ohio Appalachian Development (COAD) has expanded its Pathways program statewide, opening opportunities for CPESN pharmacies to receive and make care coordination referrals through county and regional HUBs. Pharmacies need to train or hire certified Community Health Workers and complete a credentialing process. Medicaid is the primary payment source for CHW services.

CPESN® USA has partnerships with six regional Quality Improvement Organizations for pharmacies in 23 networks to help long-term care facilities increase current COVID-19 vaccination rates for residents and staff. Cindy Warriner, a CPESN Virginia facilitator, and a senior pharmacist consultant with Health Quality Innovators, says the partnerships showcases for all federal health decision makers the value that community pharmacy brings to 65+ patients.

Laura Rhodes, CPESN Florida Managing Network Facilitator, says the network is off to a strong start with pharmacy outreach to close care gaps for plan-identified Medicaid patients.

CPESN Georgia pharmacies participating in a national Medicaid MCO program are seeing a growing number of patient encounters with positive feedback. Johnathan Hamrick, Managing Network Facilitator, says the value-based program launched last fall and focuses on improving adherence and closing care gaps

Amy Catherine Baggett, CPESN Mississippi Managing Network Facilitator, shares details of a new Medicaid MCO contract with Magnolia Health. Network pharmacists engage plan-identified patients diagnosed with diabetes or asthma to improve medication adherence. A third program for pediatric patients taking medications to treat ADD/ADHD includes counseling, and coordination with primary care providers to improve adherence.

CPESN Alabama Luminary Jessica Hung, owner of Semmes Pharmacy in Semmes, AL, describes the network's first payer program.

New CareSource Medicaid MCO statewide contract with CPESN Ohio allows all network pharmacists to provide and bill for clinical services as needed by their patients. Kevin Day, clinical pharmacist and president of Day's Pharmacy in Cincinnati and the network's Managing Network Facilitator, describes the program and opportunities it represents for CPESN pharmacies.

CPESN® USA id working with the new Vita Savings ACO to define how network pharmacies will help meet patient care metrics. Vita Savings will go live in 2025.

CPESN® pharmacies in Tennessee and Virginia closed statin adherence gaps for 50% of assigned Medicare Advantage patients, helping HMG Health System score a 4.5 CMS Star Rating.

Stephanie McGrath, Managing Network Facilitator, details how 96 Pennsylvania Pharmacist Care Network (PPCN) pharmacists met all 2023 program goals in caring for the Medicaid MCO's enrolled patients. Under the multi-service program, network pharmacists address identified patient needs, providing medication reconciliation, med sync, home visits, home deliveries, and making community and health plan resource referrals based on SDoH assessments. Learn more in this short video.

CPESN® Washington DC Metro Area is gaining new momentum with the network's first payer program to provide clinical services to Elevance Health/CarelonRx enrolled Medicaid patients. Tamara McCants, Managing Network Facilitator for the growing network, and Carla Daniel, a pharmacist with Grubb's Southeast - one of the participating pharmacies - describe benefits of the program for patients, pharmacies, and the payer.

Through a grant-funded pilot program, CPESN® West Virginia pharmacists are enrolling patients for digital monitoring and monthly reporting of blood pressure readings. Starting in three counties, network pharmacists review readings and provide individualized disease management education for patients with uncontrolled hypertension. Updates are shared with primary and specialty physicians, integrating pharmacy clinical services to care planning and delivery.

Renewal of a contract with Nebraska Total Care continues delivery of clinical services to enrolled Medicaid patients by CPESN Nebraska pharmacies. Last year, $177,000 was paid to 39 of the network's 60 pharmacies for chronic care management services - or $4,500+ per store. And the network earned an additional $34K for closing care gaps, contributing positively to the payer's overall quality ratings. Staci Hubert, Managing Network Facilitator describes the program.

Health Quality Innovators (HQI), a regional quality group reporting to CMS, has partnered with four CPESN® networks - Kansas, Missouri, South Carolina, and Virginia - to help boost current COVID-19 immunization rates for long-term care facilities. Renee Price, CPESN® Kansas Managing Network Facilitator, and Clinical Program Coordinator for Graves/Damm Pharmacies in Winfield Kansas, shares why she is excited about the new opportunity. Other CPESN networks are entering similar partnerships.

CPESN® Pennsylvania pharmacies will continue to help UPMC Health Plan's Medicaid patients manage their asthma, COPD, and diabetes medication therapy with renewal of the network's contract. More than 100 Pennsylvania Pharmacist Care Network (PPCN) pharmacies engaged with 3,360 eligible Medicaid patients in 2023 as the program added diabetes care to the program. The pharmacies also conducted more than 1,700 SDoH surveys and made 500 community and health system referrals to help patients address food, transportation, housing and other health-impacting needs.

Kim Wright, CPESN Virginia Luminary, and Rebecca Brown, Family Pharmacy Clinical Director, describe how the network's telehealth pilot with UnitedHealthcare makes doctor visits accessible to Medicaid patients without broadband or who may struggle to take time away from work to see a physician. Most exciting is the opportunity to practice at the top of their license.

Now is the time to embrace change and ramp up clinical programs as states expand pharmacy practice and health plans contract for value-based services, says Duane Jones, Arkansas CPESN Luminary. Jones, who also serves on CPESN USA's Executive Committee, gives Arkansas' test to treat law as an example of opportunity amid rapid market change. Credentialed pharmacists are paid on the medical side for office visits to treat strep, flu, and Covid-19. "Call your local network. Call your Managing Network Facilitator. Get involved."

Hawaii Medical Services Association (HMSA) recently renewed a two-year contract with CPESN Hawaii to continue a gap closure program focused on increasing adherence for Medicare patients. Kerri Okamura, Program Support Lead for the Pacific Region, says the renewal adds an annual administrative payment to the fee-for-services program.

Alison Haas, CPESN USA Director of Value-Based Contracting, does the 2023 Success Countdown with lots of wins as improved patient outcomes, achieved payer goals, and increased revenue for CPESN community pharmacies.

As CPESN Mississippi pharmacies reached out to their UnitedHealthcare patients to collect blood pressure and A1c readings, they were able to meet additional needs and help patients overcome barriers to care. Amy Catherine Love Baggett, owner of Love's Pharmacy in Diamondhead and the network's Managing Network Facilitator shares how the payer program to close HEDIS® led to care coordination successes.

Kevin Day, owner of Day's Pharmacies and CPESN Ohio Managing Network Facilitator, describes the statewide Medicaid program exclusive to CPESN Ohio network pharmacists that allows billing for provider-status initiatives without a collaboration agreement. The program for Humana's Medicaid enrollees has a January 1, 2024 start date.

Tough times, turbulent times, and unimaginable industry change - familiar words for community pharmacy. How to make it through the coming months, positioned for opportunity? Randy McDonough, CPESN Iowa and USA Luminary, and a member of the CPESN USA Board of Managers shares his insights.

John Croce, CPESN USA Program Lead for Drug Clinical Trials, describes a growing non-dispensing revenue stream for participating pharmacies through three key partnerships, with interest from additional potential partners. "In the trials that we have performed, we have far outperformed other avenues that drug trial sponsors have used in the past."

CPESN® Virginia is preparing to launch the network's first value-based payer program to provide services to Medicaid patients enrolled in an Elevance/CarelonRx plan. Lura Thompson, CPESN VA Managing Network Facilitator, shares details in this video.