< Back to Success Stories

Ground-up Partnership for CPESN® USA with Vita Savings ACO

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.

HMG Health System, Emergent ACO and CPESN® USA Partnership

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.

Medicaid MCO Contract Brings Revenue, Attracts Pharmacies for CPESN® Washington DC Metro Area

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.

HTN Patient Self-Monitoring Pilot with CPESN® West Virginia

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.

CPESN® Nebraska Renews Statewide Medicaid CCM Contract

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.

Multi-Network Program Offers Bonus Opportunity + Medicare Vaccine Rate + Fee for Time

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.

UPMC Health Plan Renews Statewide Medicaid Program in Pennsylvania

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.

CPESN® Virginia and UnitedHealthCare Telehealth Pilot

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.

Arkansas Test to Treat, Example of Practice Transformation Opportunity

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."

CPESN® Hawaii, Two-Year Adherence Contract Renewal with HMSA

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.

Happy Patients, Payers, and CPESN Pharmacists

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.

CPESN® Mississippi, Expanded Medicaid MCO Program

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.

CPESN Ohio is Statewide Pharmacy Provider Network for Humana Medicaid

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.

CPESN® USA Luminary Randy McDonough Shares Insights

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.

CPESN® USA Clinical Drug Trial Program

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, Medicaid MCO Program

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.

CPESN® Minnesota, UCare Community-Based Partnership

CPESN® Minnesota pharmacies will support prescribed use of medications for identified members enrolled in one of UCare’s Medicare plans. Lindsay Christensen, CPESN Minnesota's Executive Director, describes how network will provide direct support and education to promote medication adherence for hypertension, cholesterol, and diabetes medication, and will address gaps in statin therapy for cardiovascular health.

Successful Iowa Program Expands, Scales to Add Networks

Medicaid patients of 18 CPESN® Iowa pharmacies showed improved outcomes for their mental health, asthma, and chronic obstructive pulmonary disease (COPD) with fewer ED visits and hospital admissions. Elevance Health reported the outcomes last week, concluding that value-based partnerships with CPESN community pharmacies can be an effective strategy to improve quality and lower costs for plan members with the most complex needs. Lindsey Ludwig, CPESN Iowa Managing Network Facilitator shares the details.

CPESN® Community Pharmacy + Payers = Local, Scalable Success

Here's a preview of the 150+ Payer video stories in this showcase. It features CPESN local pharmacies from coast to coast, in small towns and in the Bronx, from the Midwest to the Deep South delivering improved patient outcomes and lowering costs through over 250 local Payer contracts. It's a story about scaling - learning from one success to build another for 41 national Payer contracts, and growing. Local. Quality. Scale.

Holston Medical Group, CPESN® NET

A strong partnership between the Holston Medical Group and CPESN® Northeast Tennessee persuaded a national health plan to restore preferred provider status to CPESN pharmacies. Samantha Sizemore, COO of HMG and its Emergent ACO made a strong case to the payer, demonstrating value to both patients and the health plan.

CPESN® Georgia Medicaid MCO Contract

Johnathan Hamrick, CPESN Georgia Managing Network Facilitator, describes the network's fee-for-service contract with a national Medicaid MCO to close car gaps for high-risk patients.

Mobility Health expands testing services available to CPESN® pharmacies

CPESN® pharmacies working with Mobility Health under a national payer program now have access to two additional lab services - the COVID-19 / Flu A&B / RSV Multiplex (four results) and the new COVID-19 Antibody saliva test. Sarah Priestle, owner of Hart Pharmacy in Cincinnati, talks about the new patient offerings.

Regional Payer Program: Mobile Immunizations for Homebound Adults

CPESN® Michigan luminary Austin Brown reminds network leaders to look in their backyards for unexpected payer opportunities with local and regional agencies.

Tips for Marketing to ACOs

Rebecca Wagers, CPESN® Northeast Tennessee Managing Network Facilitator details how four CPESN networks in three states helped Emergent ACO boost flu and fall risk scores in a 2022 year-end crunch. Now is the time for networks to approach local ACOs to offer similar support earlier.

Expanded Regional Medicaid MCO Program in Pennsylvania

CPESN® Pennsylvania pharmacists will provide onsite vaccine clinic services at community outreach events held by a payer partner under an expansion of a regional Medicaid MCO program.

CPESN® NC Pharmacies Meet RxE2 Asthma Trial Goal

CPESN® North Carolina Luminary Jessi Stout says involving a pharmacy student helped make recruitment for an asthma medication study fast and easy for her Table Rock Pharmacy in Morganton, NC. The 10 participating network pharmacies met the RxE2 program goal of qualifying 32 patients for referral to the study sponsor.

PGx Clinical Testing with Genemarkers

Through a national payer program with Genemarkers, CPESN® pharmacies are paid a flat fee to collect patient DNA samples for testing and review results with patients. The personalized medicine approach can indicate how a patient might respond to a particular treatment or which medication may work best for an individual.

CPESN® Nebraska, Medicaid MCO Renewal

Medicaid MCO coverage of adherence packaging and delivery through CPESN® Nebraska has allowed Elmwood Pharmacy to expand the service. Pharmacist Crystal Pfeifer says that's a plus for patients and for the pharmacy.

RxE2 Clinical Screening, CPESN Missouri®

Clinical Screening for Major Depression Disorder treatment study proved a good opportunity for pharmacies in the St. Louis, MO metro area to boost patient engagement and pharmacy revenue. Tyler Taylor CPESN Missouri regional facilitator, said the RxE2 program paid pharmacies for all steps regardless of outcome, saying that's "... very helpful in a world where we don't get paid for our work very often."

Expanded Medicaid MCO Program

Expansion of a Medicaid MCO program allows CPESN® Pennsylvania pharmacist to add diabetes disease management to services they provide to Medicaid patients. Additionally, they will now be paid for Social Determinants of Health screenings and referrals.