Program Highlights Opportunities for Community Pharmacies to Deliver Screening, Education, and Referral Interventions

As pharmacy programs increasingly shift toward value-based care models, there are new opportunities and strategies for community pharmacies to deliver screening, education, and referral interventions in patient care, according to speakers in a session at the Pharmacy Quality Alliance 2024 Annual Meeting.

Among a host of key health care policy trends, presenter Jon Easter, BSPharm, RPh, of the UNC Eshelman School of Pharmacy, said a common theme is expanding value-based care. However, there continue to be significant gaps in medication optimization, even as more than 50% of Americans have at least 1 chronic condition. Importantly, medication non-adherence results in $100 billion each year in excess hospitalizations, highlighting a crucial role pharmacists can play.

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“I would argue that without medication optimization, we will not achieve our goals in value-based care in this country,” Easter said.

Easter was part of the design and implementation of the Community-Based Value-Driven Care Initiative (CVCI), which began during the COVID-19 pandemic and has been running for about 3 years. It was implemented in diabetes, cardiovascular, and behavioral health screenings, with 3 main goals: systematically identify 3 clinical interventions that can be implemented in community pharmacies to improve patient care and population health; implement and evaluate the feasibility and impact of the 3 interventions; and work collaboratively to create a sustainability plan and disseminate overall findings to enhance impact and scale-up.

The sustainability aspect of the project was especially important, Easter said. To enable that, the team partnered with Blue Cross Blue Shield of North Carolina and developed networks across multiple states, urban and rural pharmacies, large and small pharmacy chains, and others.

“The reason why we did this was because it was critical from the implementation perspective to know [whether] this implementation adapts,” Easter explained.

Presenter Anna Baird, PharmD, added that foundational elements for the local implementation of the program included usable interventions, an implementation roadmap and receptive context, and relevant implementation and intervention metrics. The roadmap outlined the program’s expectations, and leaders had monthly meetings to provide feedback and change things as needed along the way.

For example, Baird reviewed the diabetes toolkit and decision tree that program participants received. It includes a large, 38-page document with in-depth information about diabetes as well as the program and a decision tree to help determine which patients to include and exclude. Participating pharmacists did a prediabetes screening with patients, and those who scored a 5 or higher underwent a second screening to identify whether it was diabetes or prediabetes. Those with diabetes and a score of 8 or higher were enrolled in the diabetes toolkit program, whereas those with prediabetes were enrolled in a diabetes prevention program.

The second step of the intervention was completion of the screening and a consultation with a pharmacist, the results of which were shared with the primary care provider.

Those who were enrolled in the program underwent 6 sessions, each of which was specifically outlined in the toolkit. Session 1 reviewed basic diabetes education; session 2 discussed nutrition and exercise; session 3 educated the patient on blood sugar; session 4 reviewed heart disease, blood pressure, and cholesterol; session 5 discussed self-care measures; and session 6 reviewed the information provided and allowed time for the patient to ask questions. The program also included mid- and end-intervention reevaluations of blood glucose and/or HbA1c, blood pressure, body mass index, and waist circumference.

Baird said most sessions were conducted virtually, with informational packets mailed to the patients ahead of time. Additionally, although the sessions were planned to take around an hour, most lasted about 30 minutes, allowing plenty of time to tailor the information to patients’ needs and questions.

Importantly, Baird said the program had a significant retention rate of more than 70%. Compared with other similar interventions that can have a retention rate around 30%, Baird said this was a great sign.

Despite the success of the program, ensuring its sustainability required a unique approach. Presenter Jasmine Perry, PharmD, CPHQ, a senior clinical pharmacist with Blue Cross NC, said the approach utilized a top-down, bottom-up methodology, including a North Carolina population health environmental scan and expert stakeholder group convened by CVCI, as well as interviews with participating pharmacies. Like Easter, Perry said the diversity of community pharmacies represented in the program was vital.

“If we are developing a program for community pharmacies and we don’t have different types of community pharmacies at the table, then the program may not be as successful as we want it to be,” she said.

CVCI convened a UNC Catalyst event in 2023 to bring stakeholders together, then created a pharmacy advisory group in June 2023, partnered with a health care technology vendor, and formed a subcommittee to continue project progression. Finally, More Than a Script was launched in mid-2024 as a pilot program in select pharmacies across the state. Perry said the goal is to fully launch the program within the next few months.

More Than a Script is an enterprise-wide program across Blue Cross Blue Shield of NC, utilizing the toolkits and background developed by CVCI. The goals are to improve members’ overall health status, increase health equity through access to care, improve HbA1c and blood pressure control, and reduce total costs of care for diabetes and hypertension. As part of the program, pharmacists will complete direct outreach to members to increase engagement, remove barriers, and improve members’ overall health and well-being.

Crucially, Perry said existing relationships with providers were identified to ease patient identification and referral, and a pathway to pharmacist reimbursement was recognized. Key considerations for the future of the program are pharmacy attribution, communication and alignment with external partners, clinical planning, reimbursement structure, and quality metrics.

Based on these findings with both CVCI and the resulting More Than a Script program, Easter concluded that aligning community pharmacy interventions with top-down findings, payers’ population health priorities, and identified unmet needs can help develop a sustainable pathway. He urged attendees to involve all stakeholders—payers, policymakers, patients, and providers—early in the program development process to ensure success and sustainability.

Reference

Easter J, Baird A, Perry J. Utilizing Community Pharmacy to Deliver Screening, Education, and Referral Patient Care Interventions: Is It Feasible and Sustainable? Presented at: Pharmacy Quality Alliance 2024 Annual Meeting. May 14-16, 2024; Baltimore, Maryland.