The Pharmacy Rewards Program Improving Outcomes Through Key Partnerships

A new value-based care initiative is putting Ohio’s community pharmacists at the center of chronic disease management for diabetes and hypertension.

“The challenge for us as a network is to perform this year,” Kevin Day, managing network facilitator at CPESN Ohio and president of Day’s Pharmacy in Glendale, Ohio, told Drug Topics. “Then, [we can] convince other Medicaid plans to start to play in this space, both in Ohio and then across the country. That scenario is: dispensing is fair, there’s sustainability and process and ability to pay for services, and the best pharmacies get rewarded.”

The Pharmacist Quality Rewards Program, a partnership between Humana Healthy Horizons in Ohio and CPESN Ohio, empowers independent pharmacists to close care gaps for Medicaid patients living with diabetes and hypertension. Rather than simply dispensing medication, participating pharmacists are now attributed patient panels, tracked against HEDIS quality metrics, and compensated for the clinical services they provide.

Day says the program is already changing how pharmacists engage with their patients. Armed with data identifying uncontrolled diabetics and patients with open care gaps, pharmacists are having deeper, more targeted conversations while looping in care teams to intensify treatment where needed.

The model aligns incentives across the board.

When pharmacists succeed, patients get healthier, plan metrics improve, and Ohio Medicaid reduces costs. Day believes this framework has real potential to scale across disease states and spread to other Medicaid plans nationwide.

At its core, the program reflects a broader shift in pharmacy’s role within health care, from dispensing to delivering outcomes. For community pharmacists willing to embrace value-based care, this initiative may represent exactly the kind of sustainable model the profession has been waiting for.

Stay tuned for weekly podcast episodes of Over the Counter powered by Drug Topics. Check out our most recent episode with Nathan Ott, PharmD, who joined us to celebrate World Immunization Week by providing some key insights on the pharmacist’s role in community vaccination as well as updating us on some key developments in the vaccination space.

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