The PQS Quality Corner Show welcomes Radha V. Patel, PharmD, MPH, BCACP, Director, Pharmacy Quality Improvement at Centene Corporation to talk about how the managed care community can engage with community pharmacies to support adherence and clinical measures like Controlling Blood Pressure.
Podcast Host Nick Dorich, PharmD, PQS Associate Director of Pharmacy Accounts asks Patel why blood pressure management and cardiovascular health is a particular focus for a health plan to work with pharmacies. Dorich and Patel also talk about how the pharmacy team can ensure these programs will be successful.
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Improving medication use of a member's hypertension regiment is one component to support blood pressure control. And a lot of this was really accelerated through the pandemic, which really resulted in more visibility. The value of pharmacies and pharmacies in helping to support patients overall healthcare. And so as a result, what we're seeing is a really a growing interest in the Medicare interest industry to really use, especially brought on from the health plans and really the ones participating in the government sponsored programs such as Medicare and Medicaid, to really partner with these pharmacies to develop programs and innovative payment models, not only to support just the adherence measures, we're also these other clinical measures, such as the CBP measure.
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Welcome to the Pharmacy Quality Solutions Quality corner show where quality measurement leads to better patient outcomes. This show will be your go to source for all things related to quality improvement and medication use and health care. We will hit on trending health topics as they relate to performance measurements and find common ground for payers and practitioners. We will discuss how the EQUIPP platform can help you with your performance goals.
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We will also make sure to keep you up to date on pharmacy quality news. Please note that the topics discussed are based on the information available at the date and time of recording. Information or guidelines are updated periodically and we will always recommend that our listeners research and review any guidelines that are newly published. Buckle up and put your thinking cap on. The Quality Corner show starts now.
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Hello Quality Corner Show listeners. Welcome to the PQS podcast, where we focus on medication use quality improvement and how we can utilize pharmacists to improve patient health outcomes. I'm your host, Nick Dorich. Our team at PQS is focused on how pharmacists and the entire pharmacy team can be leveraged as a healthcare provider and as a setting to help improve patient care.
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The ever evolving role of the pharmacist and pharmacy technician are allowing for more tests and opportunities to exist beyond the medications that are dispensed from a pharmacy. Now, while pharmacists continue to evolve their practice, it's important. We also consider how the managed care or payor community considers engaging with community pharmacies to improve health outcomes for prominent disease states.
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And for this episode, we have brought in a managed care pharmacist to gain their perspective on addressing health outcomes and how they may interact with community pharmacy efforts. So our guest today is Radha Patel, a pharmacist and director of pharmacy Quality Improvement at Centene. Radha. Welcome to the show, and how are you doing today?
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Nick I'm doing great. Thanks for having me. I'm excited to be here today with you in the quality corner of show listeners.
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Excellent. Now, right before we begin, let's get to know you and let's give the audience a chance to know a little bit about you. What's your background in health care and then what do you do in your current role at Centene?
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Sure. Well, as you mentioned, I am a pharmacist by trade, and I graduated with my pharmacy from the Philadelphia College of Pharmacy after I graduated from pharmacy school, I completed a PGI one community practice residency at the University of Georgia and Kroger and then went on to completed PGI two ambulatory care residency at the Virginia Commonwealth University and practice within the large Free clinic.
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During both of these experiences, I had the pleasure of working with many diverse patient populations and had the opportunity to implement and practice within several pharmacies run disease state clinics focusing mostly in diabetes, hypertension, anticoagulation and HIV. And I also had the opportunity during this during this time to really refine my teaching and research opportunities, which then led me to pursue and start my career in academia.
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After I finished both of my residencies, I started in academia at the Philadelphia College of Pharmacy and then later at the University of South Florida. Florida College of Pharmacy. I was there for about seven years during my tenure in academia and had the opportunity to practice in several different pharmacist run clinics. And during this time, I continue to build on my clinical experience establishing pharmacist, run hypertension management clinic and practice within the variety of diabetes and coagulation clinics under a collaborative practice agreement, and then again continue to refine my teaching and research experience and a lot of collaboration across the industry with many physicians, nurses and pharmacists to continue to develop our research experience as
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well as publications. And then as I was finishing my time in academia, I completed my Masters in Public Health with a concentration in public health practice, and that's really where my interests in managed care continue to grow. As I reflected on where I wanted to be long term, I knew that clinical programs and supporting at a population level was something that I was really interested in.
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And so in 2017, I made a career switch, started at Wellcare Health Plan, which is not simply corporation. As a manager of pharmacy quality initiatives, I was brought in as a manager over the Medicaid quality to support quality for pharmacy measures and had the opportunity to develop a lot of really innovative clinical programs. And then as my career evolved and so to continue to grow as a director and then about two years ago transitioned into the Medicare space and supporting the Medicare strategy for our three adherence measures in some measure, and that's really where I am today.
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So in my current role, I oversee the development, execution and evaluation of the enterprise strategy for these measures for our more than 1.3 million Medicare Advantage members, as well as 4.5 million PDP members. And part of this strategy is focused on innovative ways to partner with our community pharmacy partners to support quality initiatives, ultimately to drive quality, measure improvement and get closer.
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Thank you, Radha. And for today's episode, we've brought you on board to talk about how the pharmacy team can be involved with blood pressure management and screening in local and community pharmacies. We'll talk about the opportunity to improve patient care, why pharmacy is uniquely positioned, and how a managed care organization may work with other providers for such initiatives.
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Before we get into today's discussion, we need to hear a brief message from the PQS team. We'll be right back with the questions after the breakdown.
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Now it's time for the breakdown as quality corner show host little as three main topic questions. Our guests will have a chance to respond. And there will be some discussion to summarize the key points This process will repeat for the second and third questions, which will wrap up the primary contents. And it's the 40. After that, I expect to end on a closing summary, usually containing a bonus question.
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Now that we have the start of the process, let's jump into the questions.
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We're back. And for the purposes of today's episode, the focus is going to be how payers, how managed care organizations are engaging with pharmacist in pharmacies and new and unique ways for blood pressure management. The why question is always a great place to start. So for our first question, Rhonda, why is blood pressure management and cardiovascular health a particular focus for a health plan to work with pharmacies?
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Yes, of course. Yeah, you're absolutely right. It is very critical. So according to the CDC, cardiovascular disease, which is often referred to as the silent killer, is the leading cause of death in the United States and accounts for more than $219 billion in health care spending in 2021. So cardiovascular disease is really a compilation of several conditions which can affect the heart and blood vessels commonly caused by plaque buildup in the wall of the arteries, which we refer to as atherosclerosis and and as well as high blood pressure.
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And so what these conditions are untreated or poorly managed, it can really lead to progression of cardiovascular disease such as heart attack, stroke, heart failure, arrhythmias and heart valve problems. While we think about risk factors for this, it's usually being high blood pressure and accounts for usually brought on by poor diet, lack of exercise and overall lifestyle. There are some other irreversible risk factors that we know of.
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This includes age, family, history, race and ethnicity. And so for all these reasons, and given the high prevalence of cardiovascular disease in our population, quality measures have been developed mainly by the NCQA and the Pharmacy Quality Alliance for Health plans, providers and pharmacies in order to evaluate how well they help to support their patients with the management of high blood pressure.
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And this really ranges from medication adherence to overall blood pressure control.
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Excellent. Right. I'd like to talk more about these measures that are considered because pharmacists and most folks working in pharmacy are really only familiar with a handful of quality measures at this time, typically around medication adherence. But we know in the larger health plan space for health plans and hospitals health systems, there are literally hundreds of quality measures that can be applicable.
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So for this next part, are these measures that you referenced, are they solely related to medication use? Are there other measures that pharmacies can impact related to blood pressure, test screening and management?
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Yeah, you're absolutely right. There are many different measures that can overall impact on how quality is measured from a blood pressure perspective. The two that we most commonly see from a health plan perspective is the HEDIS controlling blood pressure measure, which we refer to as the CBP measure, and then the PQA hypertension medication adherence measure, which is the one that you just referenced.
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Both of these measures have been adopted by the CMS Medicare Stars rating. So to focus a little bit more, the CBP measure is really the percentage of members who have hypertension and are adequately controlled in their blood pressure each year. And the peak adherence measure, also referred to as the RASA measure, evaluates medication adherence for the angiotensin one antagonist class of medication, and that uses a proportion of days covered calculation using pharmacy claims.
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And so as we think about what adherence means from a quality perspective, usually it's translated to a member or patient having a PDC greater than 80% for the calendar year. And so to answer your second question, while we often think of pharmacy as being able to support the medication use part of the quality measure, we have been seeing a shift in pharmacies being leveraged more for these additional clinical services to help support some of the non medication use measures or in places where appropriate medication use can result in improved clinical outcomes.
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So for the purposes of this discussion, improving medication use of a member's hypertension regiment is one component to support blood pressure control. And a lot of this was really accelerated through the pandemic, which really resulted in more visibility in the value of pharmacies and pharmacies and helping to support the patients overall health care needs. And so as a result, what we're seeing is a really a growing interest in the managed care interest industry to really.
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Yes. Especially brought out from the health plans and really the ones participating in the government sponsored programs such as Medicare and Medicaid, to really partner with these pharmacies to develop programs and innovative payment models, not only to support just the adherence measures for also these other clinical measures, such as the CBP measure now.
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Now Radha, of these opportunities for patients of the community pharmacy at the community pharmacy, they're the patients for you as the health plan their members. But these opportunities to engage with blood pressure management, they might be new for pharmacy, but it is not new to managed care organizations or health plans that have already engaged or are engaged with other providers in value based payment systems to manage blood pressure or health outcomes As it relates to blood pressure.
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In examples like this, what are the expectations for the health care provider and what should the pharmacy team understand to ensure that these programs are seen as successful?
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Yes, you're absolutely right. Payers and providers have been working in any value based payments system for many years to help support quality measures. While some of this may be new to pharmacies, it is definitely an exciting opportunity and exciting time as we think about the role of the pharmacist and the pharmacies in helping to support not just medication adherence to blood pressure, but also all the other clinical components of the CBP measure.
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And it really is truly a partnership between the health plan, pharmacy and even the providers to work together to provide appropriate clinical care to the patients. And so these innovative payment models that allow pharmacies to take on additional clinical responsibilities are important and will support and elevation the pharmacist role in driving overall clinical improvement. What we want to ensure is that our pharmacy partners really recognize that these clinical opportunities should not be seen as just tests, but really embraces clinical opportunities to provide education and drive member behavior change to support overall gap closure and optimal health outcomes for the patients.
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So the success of the program is really going to be on the outcomes.
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Now, right of the service may or may not be available or presented to all pharmacy teams yet, but that doesn't mean we can't educate ourselves or we can't learn about them. So let's put ourselves in the shoes of the community pharmacy. And if you work for a pharmacy or an organization that supports community pharmacies, how would you start to inform and influence your pharmacy operations to support such programs, such as blood pressure screening, so that when these opportunities launched that you can hit them right away and be ultimately successful?
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So that's a great question. And the short answer really is it's going to be dependent on the pharmacy itself. As a payer, we recognize that not all pharmacies operate the same or may have the same workflow. So a self-assessment on how these programs could be operationalized within a day to day manner is going to be critical. So level a level of pre-planning is going to be required in order to ensure that there is no disruption in the services that are being provided.
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Now I recognize that that is easier said than done, but it really does require embracing change, leadership, buying and being able to provide the pharmacy team delivering these services, the appropriate tools and resources necessary to be successful. While we recognize that the dispensing of medication is pivotal to the work of the of the pharmacy pharmacies, to really look at these opportunities not only as additional sources of revenue for the pharmacy, but also as a means to strengthen the patient pharmacist relationship and as a strategy strategy to support retention of those members, filling up those pharmacies.
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These clinical services are starting to become differentiators in our industry and over time may impact the patient's decision to stay on with those pharmacies or choose to go to a different pharmacy. So as we think about all of this pharmacist, you really start thinking about how they can start providing services to their patients. That's then outside of dispensing to start setting themselves up for success.
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This could include ensuring that there's appropriate training within the staff, participation in health screenings, whether it be within the pharmacy or in the community, and really starting to starting or continuing to build a relationship with key provider groups and health plans in the area.
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Right. An excellent answer. And I think this really fits with the mantra of prior planning prevents poor performance. So the information and the details are there for pharmacies. We really encourage them to start looking and start planning for these opportunities so you can hit the ground running. Now for our final question, this show, the Quality Corner Show, focuses on really one main idea, and it's an important one improving patient health outcomes obtain a blood pressure.
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Reading itself is not the only thing that matters when taking care of the patient. How does a blood pressure screening create a meaningful opportunity for pharmacist and the pharmacy team and the health care team to provide other services with a patient now and in the future?
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Yeah, and that's really another great question. And you're absolutely right. We've been talking mostly about blood pressure management and the role of the pharmacy. But these type of services are really the catalyst for opening the doors for more opportunities, for more patient engagement and building and strengthening that pharmacist patient relationship that I referenced earlier. Pharmacies are highly integrated in the care of their patients, will often see healthier patients that stay with those pharmacies and as well as those patients that are more likely to continue to engage in other services being offered by the pharmacy, whether it be through vaccination services or other clinical services such as a one seat screening, just to name a few.
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And lastly, so as the landscape of the quality measures continue to evolve and the role of pharmacies is becoming a pivotal part of many payer strategies, the pharmacies that show a commitment to supporting our members and their patients in delivering on quality measure results are more likely to continue to be engaged by payers, choose to continue to deliver and grow their services across a variety of different measures.
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Excellent. Well, Radha, thank you very much for the information today. Really excited to be having a health plan and health plans that are partnering with pharmacies to engage the patients on optimizing their medication therapy regimen, but also providing screenings of their health and wellness services. And as we talked about, one of the questions, the main questions here was how is success or how do we view success for the program?
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And it's ultimately pharmacies engaging, getting good results, taking care of the patients. That's what is going to allow these sorts of programs grow and expand to potentially other pharmacies, but also for other services. So we're really excited for it. I really appreciate you coming on the show today to talk about these sort of items and to help share the spread, the message and how our team is looking to work with pharmacies.
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But now we've reached the point in the show where we have some different questions or different set of questions for our guests. These are not necessarily related to health care and pharmacy. However, if you choose to add details about that, that is perfectly fine. So, Radha, are you ready for our rapid fire questions?
00:20:09:12 - 00:20:11:05Radha P
All right, I'm ready for it.
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Excellent. First question. Are you a morning person or a night owl?
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Definitely a night owl.
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Okay. I have to ask her at the follow up question here. What time does that mean, as usual, bedtime.
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Well, if I'm in bed, I can be up in bed by nine and Night Owl would be like to go to sleep maybe around 11.
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Okay, that sounds very similar this week and had a conversation with one of my one of my good friends, perhaps another teammate who had said the same thing. Bedtime gets into bed at nine but watches things on their phone or tablet until about 11. So you're not alone and you're with good company. I can tell you that. Our next question Do you prefer to read the book or watch the movie?
And if you have any particular examples, we'd love to hear them.
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Yeah, watching a movie definitely probably would be my preference. Recent example. It's been a while I Mother's Day. So it it has definitely has been a while so I can't think of one right now off the top of my head.
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Not a problem here. Our next question What is your recommendation for living a healthy life?
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Yeah, so it's like the usual response eating healthy and staying active. My recommendation is really to take to make sure to always take a break, maybe go on vacation, take some time for self-care, whether that means going to a spa, spending time with family, friends, or even just having some alone time.
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Excellent. And then our final question here, Radha, what is one goal, personal or professional that you are working towards?
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Yeah. So, you know, aside from following my own recommendation of living a healthy or what living a healthy life should be like, but I would say definitely one of the things that I'm working on is really being more attention in slowing down and taking that time for self-care and hopefully maybe being able to read a book or watch a movie would be really nice from time to time.
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But, you know, right now in the season of life that I'm in with two little kids, that's just a little bit challenging, but definitely taking time to just slow down and really enjoy the little moments, especially with my family.
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Got it. Yeah. If there's any movies watching, it might be things like Frozen or Moana, which I'm not saying is bad. Actually.
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The movie was very good.
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There you go. All right. All right. I really appreciate you coming on onto the show and talking about how health plans or how your health plan is engaging with pharmacists and pharmacy teams to provide these patient care services, improve patient health outcomes. It's a really exciting time in the pharmacy landscape. But folks, they may have questions for you.
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They may want to learn more information if they if they do have questions. Or as a follow up from this episode, is there a way that they can contact you?
00:23:07:20 - 00:23:28:00
Yeah. Yeah. So again, thank you for having me. It's been a pleasure. And that really commends you all for bringing light to the work that's being done and really highlighting this opportunity for the pharmacies and supporting quality measure. But to answer your question, yes. So my email, the best way to get in contact with me would be through email.
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Radha.V.Patel@centene.com or through LinkedIn.
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Excellent. Radha, again, thank you very much for joining today's show. And with that, we have wrapped up this episode for our audience. We thank you for joining us today and we hope you listen to our next episode of The Quality Corner Show. Before we go, we have one final message from the PQS team.
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The Pharmacy Quality Solutions Quality Corner show has a request for you. Our goal is to spread the word about how quality measurement can help improve health outcomes. And we need your help in sharing this podcast to friends and colleagues in the health care industry. We also want you to provide feedback, ask those questions and suggest health topics you'd like to see covered.
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If you are a health expert and you want to contribute to the show or even talk on the show, please contact us. You can email info at pharmacy quality dot com. Let us know what is on your mind, what we can address so that you are fully informed. We want you to be able to provide the best care for your patients and members, and we wish all of you listeners out there well.