The Pharmacy-Health Plan Partnership: Driving Diabetes Outcomes

This episode of the Pharmacy Quality Solutions Quality Corner Show explores the critical, coordinated efforts between health plans and pharmacies to improve patient health outcomes, particularly in light of National Diabetes Month (November), recognizing that over 38 million Americans live with diabetes.

Podcast Host Kerri Musselman, Director, Clinical Transformation, Pharmacy at PQS by Innovaccer discusses with guest Bahar Davidoff, VP, Clinical Programs & Pharmacy with SCAN Health Plan, insights on how community pharmacies can transition from a focus on prescription dispensing revenue to a successful clinical service model.

Chapters

• 1:09 Introduction
• 4:03 The Shift to Clinical Value
• 8:08 Changing Workflow
• 9:03 Community Touchpoints
• 10:09 Incentives to Pharmacies
• 11:52 A Plan for Improving Outcomes for Patients with Diabetes
• 14:44 Reviewing Patient Details
• 15:44 Leveraging Connection Points
• 17:31 Documenting Patient Data Points
• 18:18 Closing

Transcript

00:00:01:10 - 00:00:14:17
Kerri Musselman
Taking this just a little bit further, and this is more forward thinking. Are there data points or patient details that you think the pharmacy can document so that health plans and pharmacy can further collaborate to improve patient and the health plans?

00:00:14:17 - 00:00:16:16
Kerri Musselman
Case number outcomes?

00:00:17:02 - 00:00:56:04
Bahar Davidoff
I think that would be incredible. if pharmacists can document the blood pressure of the members, the, blood sugar levels of the member. I think, the provider would love to see that information as well. So, those two things are key. If they can do point of care testing for LDL, and triglycerides. Those are key information that the providers as well as the health plan would benefit from knowing.

00:00:57:00 - 00:00:58:23
Voiceover
Welcome to the pharmacy

00:00:58:23 - 00:01:07:04
Voiceover
Quality Solutions Quality Corner show. Buckle up and put your thinking cap on. The Quality Corner show starts now.

00:01:07:17 - 00:01:11:13
Kerri Musselman
All right. So welcome everyone to the Pharmacy Quality Solutions

00:01:11:13 - 00:01:12:16
Kerri Musselman
show.

00:01:12:18 - 00:01:41:21
Kerri Musselman
Hi everybody. My name is Kerri Musselman and I'm going to be moderating today with Bahar Davidoff. We'll go through introductions here in a little bit. Welcome to our 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, and on today's episode we wanted to highlight that November is National Diabetes Month and that over 38 million Americans are living with diabetes.

00:01:41:23 - 00:02:11:09
Kerri Musselman
It's a condition that demands constant management, and the success of that management doesn't just rest on the patient. It's a team effort. Today, we are zeroing in on two major players in the health care ecosystem whose coordinated efforts are absolutely critical in driving better patient outcomes. Health plans and pharmacies. These organizations are on the frontlines managing everything from medication cost and coverage, the patient education and insurance.

00:02:11:11 - 00:02:34:02
Kerri Musselman
So how exactly can health plans and pharmacies work together this month and every month to move the needle on key metrics like A1C control and medication adherence? We'll be discussing the shift to clinical value, incentives to pharmacies and a future provider role. Stay with us as we unpack the critical role of these partnerships in the fight against diabetes.

00:02:34:04 - 00:02:43:07
Kerri Musselman
I would love to introduce my co our panelists today. Bahar. Bahar is the vice president for pharmacy with Scan. Welcome to the show. Bahar.

00:02:43:07 - 00:02:48:03
Kerri Musselman
Hello. Thank you so much for having me. I'm really excited to be a.

00:02:48:03 - 00:02:50:04
Kerri Musselman
It's great. How are you doing today?

00:02:50:04 - 00:02:52:11
Kerri Musselman
Great. Thank you.

00:02:52:11 - 00:02:57:06
Kerri Musselman
Can you provide our group and our users some additional information about your background

00:02:57:06 - 00:02:58:20
Kerri Musselman
that someone may,

00:02:58:22 - 00:03:25:16
Bahar Davidoff
Definitely. I’m a pharmacist by training. I started in retail at Rite Aid and then moved on to hospital and later to medical group. And I was there with the medical group for 12 years. There I worked very closely with our executives to build, clinical programs through collaborative practice agreements for our pharmacies. And then about a year ago.

00:03:25:17 - 00:04:00:08
Bahar Davidoff
I joined SCAN because I felt that it was at the health plan, that I could really make a difference in pharmacy. And so I'm really excited to be with SCAN health plan. We're a nonprofit organization, a local plan. So the majority of our members in Europe that use independent pharmacies, because of that, we have partnered very closely with Independent Pharmacy and are looking forward to, innovating in that space.

00:04:01:06 - 00:04:35:24
Kerri Musselman
Well, we're very excited to have you, and I'd love to be able to get your perspective on all of your background for our diabetes podcast. Thank you. So whenever we're ready, we'll go ahead and go to the first question. So first, talking about the shift to clinical value for community pharmacy that historically relied on prescription dispensing revenue. What are the 2 to 3 most critical operational and cultural changes that need to implement now to effectively transition to a successful clinical service model?

00:04:36:19 - 00:04:37:16
Bahar Davidoff
What are your thoughts?

00:04:37:16 - 00:05:06:20
Bahar Davidoff
I so I'm really excited because now is a great time to do that. To to your point, there's multiple ... shifts that need to happen to allow independent pharmacies to be able to, have pharmacists practice at the top of their license, especially if we're talking about diabetes, for example. We know that our members are coming into the pharmacy multiple times a year.

00:05:06:22 - 00:05:39:23
Bahar Davidoff
It's not every month. I think that they can definitely not, concerted approach to, not just, to dispense the medications, but actually provide clinical value to them. And so the first, shift that needs to happen is to go from that dysfunction to providing value, which is the quality of the intervention that the pharmacists come, with.

00:05:39:24 - 00:06:14:03
Bahar Davidoff
A1C’s diabetic foot checks for Chuck's reminding our, our members, their patients to do eye exams annually. And, being mindful of the fact the medications are having on providing good health outcomes for our members. So, I think that's the first one. And, second, I think we need to change the workflow in the pharmacy.

00:06:14:05 - 00:06:49:17
Bahar Davidoff
So, for example, now we're working very closely with the USC School of Pharmacy to enhance what technicians can do to be able to support pharmacists to provide better clinical care. And so that would be blood pressure, A1C, cholesterol. Starting out with a comprehensive medication management to do a medication reconciliation. We actually are even working with pharmacies now to do a post hospital discharge medication reconciliation.

00:06:49:17 - 00:07:20:11
Bahar Davidoff
So we're hoping to provide them the list of medications that our members worked on before they went to the hospital, the list that they were on during the hospitalization, and then for the pharmacist to reconcile that. And provide their recommendations to the primary care physician at the post hospital discharge appointment, which is supposed to happen within 30 days.

00:07:20:13 - 00:07:50:11
Bahar Davidoff
And, as you know, that's a quality measure. So a bill. So there's a lot of opportunity for us to enhance what pharmacists can do. And then lastly, they need to get reimbursed for their services. So, how can we do that? That would be met through medical billing. Probably. Point of care testing. There's a lot of states that have have Test to Treat for Strep, Covid, flu.

00:07:50:13 - 00:08:06:17
Bahar Davidoff
But I think the terms enhance all of that by, supporting the pharmacists, getting, the building, you can get reimbursement for their services.

00:08:07:16 - 00:08:17:07
Kerri Musselman
Okay. Well thank you. I'm going to lean into a couple of the things that you just mentioned. So the first one you had mentioned that patients or members go to their pharmacy often.

00:08:17:09 - 00:08:24:05
Kerri Musselman
So how do you recommend or looking at the maximum touchpoints that that patients see in the community setting?

00:08:24:18 - 00:09:02:04
Bahar Davidoff
We can leverage those touchpoints to remind, diabetic, members to do their A1C testing to, so that they can discuss that with their primary care physician. If the medication to have dose adjustments. And I think pharmacists are definitely, positioned well to be able to do that for the members and let them know that we should make, regimen modifications, dose modifications to reach your goal for your A1C.

00:09:02:22 - 00:09:03:03
Kerri Musselman
Perfect.

00:09:03:06 - 00:09:21:09
Kerri Musselman
Thank you. And one of the second item that she mentioned was the change in workflow. So what are some of the areas that she would recommend for folks as we start looking at pharmacists and pharmacies needing to change how they work through their workflow to be able to integrate these types of clinical services.

00:09:22:01 - 00:09:31:15
Bahar Davidoff
So obviously, pharmacies have to make sure that they have a workflow that, allows them to dispense medication.

00:09:31:17 - 00:10:08:11
Bahar Davidoff
But I think there needs to be an evaluation of how do you allow technicians to be able to do more so that the pharmacist can, be less involved, in they, dispensing, and more on the clinical side. And so that is really important. We're trying really hard to provide education for technicians as well as certifications, so that they can do more in the pharmacy to allow the pharmacist to do more clinical work.

00:10:08:23 - 00:10:27:19
Kerri Musselman
Hence the partnership that you guys have with the college to be able to do the training. Is that right? Perfect. So now that we've talked about the shifts to clinical value, we're going to transition a little bit to one of the third points that I mentioned, which is the reimbursement or payment. So looking at incentives and risk sharing.

00:10:27:21 - 00:10:48:24
Bahar Davidoff
So pharmacy like the rest of the healthcare world continues to evolve beyond the fee for service payment for individuals regarding clinical encounters. How can health plans design value based share savings models that directly tied to a pharmacy's reimbursement to achieving specific, measurable improvement in patient health outcomes?

00:10:48:24 - 00:10:59:15
Bahar Davidoff
So one other thing that you pointed out is value based payment equals health outcomes.

00:10:59:17 - 00:11:32:07
Bahar Davidoff
So if we are able to track and monitor if a pharmacy is able to track and monitor what the outcomes of the member is in terms of their cholesterol, their blood pressure, their A1C, then they will be able to get paid for those outcomes. And so we need to partner with, platforms that allow pharmacists to have access to that information.

00:11:32:07 - 00:11:53:05
Bahar Davidoff
they need for, the lab, for example, or even prescribe the lab to, so that the member can go to the lab. The pharmacist gets the information so they can make those modifications and regimen modifications.

00:11:53:10 - 00:12:05:18
Kerri Musselman
So given that this is the diabetes month for November, what are your thoughts on defining a plan that has improvement of outcomes specifically for diabetes, such as A1C control?

00:12:05:18 - 00:12:12:06
Kerri Musselman
You mentioned the robust plan you guys have for reducing hospitalizations within the population that you guys serve.

00:12:13:00 - 00:12:41:14
Bahar Davidoff
One of the most important, issues that we need to address with members who have diabetes is adherence., We see that adherence is definitely a problem that can be addressed by the pharmacist. And maybe that's through addressing side effects or, that there is a lack of knowledge about the importance, of adherence.

00:12:41:16 - 00:12:49:03
Bahar Davidoff
So I think that's where pharmacists can definitely message their friends. The other one,

00:12:49:03 - 00:13:18:02
Bahar Davidoff
avoiding high cost complications. So whether that's ... events or readmissions, we know that there are, admissions due to DKA ... hypoglycemia. And so the more education that the pharmacist can provide to their patients regarding the medication that they're on, the importance of adherence.

00:13:18:04 - 00:13:55:04
Bahar Davidoff
And the education about the outcomes of the A1C, and what it translates to, for them, for their health outcomes, not just within a few years, but even further, where we can discuss what are the ramifications on their vision or their kidney, which can lead to dialysis if untreated. Even amputations from not doing that, the routine foot exams.

00:13:55:11 - 00:14:05:24
Bahar Davidoff
So it's very important that pharmacists see themselves as clinicians that can make a huge difference in our patients with diabetes.

00:14:06:08 - 00:14:23:08
Kerri Musselman
Okay. I think you summed that up pretty well, when we start looking at the value based clinical programs and where pharmacy can kind of lean in. So moving into when we start looking at continuous care, the pharmacy team engages with patients more often than the provider.

00:14:23:08 - 00:14:44:08
Kerri Musselman
As we talked about a little bit earlier. And when we look at value based care and health outcomes, we are often measuring outcomes over a longer period of time. We know that over a period of time, the patient behavior and situations do change. As long as pharmacy transitions from a practice of filling prescriptions to continuous patient monitoring and feedback.

00:14:44:10 - 00:14:51:17
Kerri Musselman
What details should pharmacy team members review with their patients as they're filling their medication? Especially adherence.

00:14:52:06 - 00:15:19:21
Bahar Davidoff
I think they should review what medications they are on. They should review how to test their blood sugar. The importance of testing, how to keep track of their blood sugar level and then how they modifications if they have, if they have a reading that's higher than expected or lower than expected.

00:15:19:23 - 00:15:44:23
Bahar Davidoff
And also all of the other preventative measures that members need to do for keeping healthy. I think pharmacies can even discuss or should discuss, the lifestyle modifications as it pertains to their medications

00:15:45:13 - 00:15:58:20
Kerri Musselman
Taking this just a little bit further, and this is more forward thinking. Are there data points or patient details that you think the pharmacy can document so that health plans and pharmacy can further collaborate to improve patient and the health plans?

00:15:58:20 - 00:16:00:19
Kerri Musselman
Case number outcomes?

00:16:01:05 - 00:16:40:07
Bahar Davidoff
I think that would be incredible. if pharmacists can document the blood pressure of the members, the, blood sugar levels of the member. I think, the provider would love to see that information as well. So, those two things are key. If they can do point of care testing for LDL, and triglycerides. Those are key information that the providers as well as the health plan would benefit from knowing.

00:16:41:10 - 00:17:25:09
Kerri Musselman
All right. Well, thank you so much Bahar, for the conversation today. So just kind of as a recap, as we start looking at the Diabetes Awareness Month, utilizing pharmacies and health plans as a partner and medication adherence, clinical monitoring type programs such as blood pressure and A1C, working through and checking A1Cs, blood pressures and or cholesterol levels at the pharmacy using point of care testing and then being able to uniquely shape pharmacies in a value based care payment model with risk care and options to improve health outcomes, clinical monitoring, the clinical outcomes, as well as reduction of readmissions and using pharmacy to assist with the

00:17:25:09 - 00:17:27:22
Kerri Musselman
discharge reconciliation.

00:17:27:24 - 00:17:31:12
Kerri Musselman
Anything else that I missed today that we covered that was pretty high level.

00:17:31:15 - 00:17:54:16
Bahar Davidoff
One of the things that I think I didn't touch on that is very important is if we can leverage those connection points with the pharmacies to also address social determinants of health. So if there's access issues to the pharmacy, to the medical due to cost. If there is a, lack of education?

00:17:54:18 - 00:18:10:21
Bahar Davidoff
I think all of those are things that pharmacists can also address and would make an important... would make, a big difference in the member's health outcomes.

00:18:11:06 - 00:18:20:10
Kerri Musselman
So true. Pharmacy is well positioned to be able to take a look at the patient's understanding, because how many times have they go to a counter and they say, oh I can't afford this.

00:18:20:10 - 00:18:24:18
Kerri Musselman
And so you're having to work through on the back end to help them figure that out.

00:18:24:20 - 00:18:41:07
Kerri Musselman
Great call out. Thank you so much. All right. Well, thank you everybody for listening to our show today. It's been a pleasure having you, Bahar, to join us and answer some questions. So we want to thank you for joining us. We hope you listen to the next episode of the Quality Corner Show.

00:18:41:09 - 00:18:45:21
Kerri Musselman
And before you go, we have one final message from the PQS team.

00:18:46:09 - 00:18:50:11
Bahar Davidoff
It was my pleasure, to be here. Thank you so much for having me.

00:18:50:23 - 00:19:13:23
Voiceover
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00:19:14:00 - 00:19:33:11
Voiceover
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00:19:33:11 - 00:19:38:05
Voiceover
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