Policy recommendations issued by the Center for Medication Optimization through Practice and Policy at the University of North Carolina at Chapel Hill call for Medicaid reforms to optimize the benefits of medication and include community pharmacists as an important part of the health-care team.
Building on existing efforts in North Carolina, the recommendations include the following:
- Using models developed from the growing Community Pharmacy Enhanced Services Network to allow health plans to develop community pharmacy pay-for-performance models focused on overall cost of care and quality.
- Testing the community pharmacy enhanced services care management model within health plans and comparing plan performance on economic and clinical outcomes and patient and provider satisfaction.
- Allowing plans to expand pay-for-performance models of clinical pharmacy services to areas including care transitions, immunizations and chronic pain management.
- Encouraging health plans to include high-performing pharmacy networks into value-based care models to improve care integration and coordination.
The center is part of the UNC Eshelman School of Pharmacy. Jon Easter is its director and a professor of the practice at the School.
“We know that most physician visits, ER visits, and hospitalizations result in one or more medications being prescribed,” Easter said. “It makes sense to enlist pharmacists as a part of the care team to ensure that we optimize the benefits from those medicines to improve health.”
Currently, North Carolina is home to one of the most prominent examples of collaborative care engaging community pharmacists to make a difference for Medicaid enrollees, Easter said. More than 250 pharmacies across the state participate in the Community Pharmacy Enhanced Services Network, a model that is spreading across the county.
Community Care of North Carolina created the network in 2014 through a three-year cooperative agreement with the Center for Medicare & Medicaid Innovation. CCNC, a physician-led group that contracts with the state of North Carolina to care for enrolled Medicaid beneficiaries statewide, saw high performing community pharmacies as an opportunity to expand and improve the delivery of care-management services.
In 2015, the U.S. spent $325 billion on prescription medicines – or about 10 percent of total National Health Expenditures. Estimates of the $200 to $300 billion associated with the underuse, improper use, and misuse of medications suggest that nearly an additional dollar is spent addressing a medication misadventure, presenting significant opportunities for enhanced pharmacy services to address these challenges, improve quality and lower costs.
The Center for Medication Optimization through Practice and Policy is an interdisciplinary research center at the Eshelman School of Pharmacy at UNC Chapel Hill. CMOPP brings together health-care stakeholders to conduct real world research, generate evidence, disseminate best practices and advance education that integrates medication optimization into value-based care delivery and payment models. CMOPP’s Twitter handle is @UNC_CMOPP.