Strong engagement with patients diagnosed asthma or diabetes, and pediatric patients diagnosed with ADD/ADHD led to program renewal with Magnolia Health, the Medicaid MCO in Mississippi. Amy Catherine Baggett, managing network facilitator, says sharing patient impact testimonials and pharmacy results with the MCO also allowed expansion to include collecting HbA1c for diabetes patients.

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.

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® 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.