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Initiative promotes adoption of value-based care models in community pharmacy settings.
Outcomes-based programs, also sometimes referred to as value-based programs, focus on quality of care, rather than quantity of patient visits, to encourage providers to deliver interventions that improve patient care and outcomes.
HealthPartners (HP), a regional health plan based in Minnesota, embodies this “pay for value” philosophy through its Partners in Excellence (PIE) program. Pharmacists are eligible to participate in the medication therapy management (MTM) program by providing comprehensive medication management (CMM), as defined by the CMM patient care process, encounters, and value-based compensation through clinical performance and engagement performance metrics.
The HealthPartners’ PIE program is a performance and recognition program for physicians, medical groups, and pharmacies that achieve top marks in patient-centered metrics including health, experience, and affordability. The health plan evolved and expanded its MTM program after internal analyses demonstrated a significant return on investment when high-risk patients receive CMM services. Pharmacy providers are eligible for performance-based payments associated with achievements in blood pressure control, diabetes control (A1C), and a tobacco-free lifestyle. Pharmacy entities meeting performance benchmarks for clinical metrics are then eligible for a second-tier performance payment based on plan member engagement in CMM services.
HP views community pharmacist as an integral part of building a strong network of CMM providers for patients; however, these pharmacists often experience competing priorities and unique barriers that limit participation.
The Slice of PIE initiative is a collaborative effort between HP, the University of Minnesota (UMN), the University of North Carolina (UNC), and the Alliance for Integrated Medication Management designed to improve and increase delivery of CMM within the HP CMM provider network. Twelve Minnesota community pharmacy organizations, representing over 100 pharmacies, are engaged in the initiative. Implementation supports that help expand patient access include lists from HP identifying patients in most need of CMM interventions, a community of learning that connects participants across the initiative, frequent meetings with implementation coaches, monthly learning events (webinars), and additional strategies designed to help support expansion of patient access.
Slice of PIE will investigate research questions defined under 3 separate study aims. First, the initiative will evaluate the eectiveness of the learning collaborative as an implementation strategy to drive the adoption and sustainability of CMM delivery. The second aim will be to rigorously evaluate the implementation inputs and patient outcomes of initiating the PIE program in community pharmacies. Third, the research team will determine the clinical effectiveness and sustainability of the interventions delivered by Slice of PIE participants.
This initiative has the opportunity to change the trajectory of outcomes-based care nationally, thereby allowing patients across the country access to enhanced care and better health outcomes.