Outcomes in Medicaid Members Engaged in Health Plan, PBM, and Community Pharmacy Collaboration
An analysis of a collaboration between Elevance Health and a network of independent community pharmacies demonstrated improved outcomes for Iowa Medicaid members who engaged with the program to manage their complex or chronic conditions.
Pharmacists are increasingly valued for their role in managing chronic diseases, as demonstrated by the rise in outcomes-based contract arrangements with pharmacy benefit managers (PBMs). Pharmacists have evolved their clinical services to include not only medication dispensing and adherence but also medication therapy review, patient health education, and counseling. They can play an important role in care management and have been shown to positively impact pharmacy-related outcomes.
This brief highlights how Iowa Medicaid members with higher healthcare needs experienced a favorable change in medical services utilization, higher rate of improvement in quality of care HEDIS gap closures, and reduction in medical costs for their chronic conditions compared to members who did not engage in the program.
Related Public Policy Research
Medicaid Prescription Drug Management: Quality Scores Compared Across Different Approaches
Data show that states that employ managed care organizations (MCOs) to manage the Medicaid prescription drug benefit collectively exhibit higher scores on pharmacy-related clinical quality measures than states that rely on the fee-for-service (FFS) setting to administer the benefit.
PBM and Community Pharmacy Partnerships Can Improve Medicaid Outcomes
Individuals’ visits to community pharmacies outnumber visits to other healthcare provider types by nearly 2:1. Value-based care arrangements between pharmacy benefit managers (PBMs) and independent community pharmacies, where enhanced services are performed, can improve outcomes for individuals at higher risk for poor health outcomes.
There is a growing understanding of the clinical roles that pharmacies and pharmacists can play, beyond medication dispensing and adherence, such as medication adjustment, vaccination, and outcomes monitoring. Value-based payment (VBP) in pharmacy has the potential to recognize the contributions pharmacies and pharmacists can offer to improve patient outcomes and reduce costs.
Subscribe
Keep up with our latest news, research, and stories.
Subscribe to financial alerts on our investors site