A Partnership to Optimize Medication Use and Patient Outcomes

Outcomes-based programs, also sometimes referred to as value-based programs, focus on quality of care, rather than quantity of patient visits, to encourage providers to deliver interventions that improve patient care and outcomes.

Last summer, the Drug Topics article “How Pharmacists Benefit Value-Based Programs” highlights the role of pharmacists in some of these payment programs. HealthPartners (HP), a regional health plan based in Minnesota, embodies this “pay for value” philosophy through its Partners in Excellence (PIE) program. Pharmacists are eligible to participate in the medication therapy management (MTM) program by providing comprehensive medication management (CMM), as defined by the CMM patient care process, encounters, and value-based compensation through clinical performance and engagement performance metrics.

The HealthPartners’ PIE program is a performance and recognition program for physicians, medical groups, and pharmacies that achieve top marks in patient-centered metrics including health, experience, and affordability. The health plan evolved and expanded its MTM program after internal analyses demonstrated a significant return on investment when high-risk patients receive CMM services. Pharmacy providers are eligible for performance-based payments associated with achievements in blood pressure control, diabetes control (A1C), and a tobacco-free lifestyle. Pharmacy entities meeting performance benchmarks for clinical metrics are then eligible for a second-tier performance payment based on plan member engagement in CMM services.

HP views community pharmacist as an integral part of building a strong network of CMM providers for patients; however, these pharmacists often experience competing priorities and unique barriers that limit participation.

The Slice of PIE initiative is a collaborative effort between HP, the University of Minnesota (UMN), the University of North Carolina (UNC), and the Alliance for Integrated Medication Management designed to improve and increase delivery of CMM within the HP CMM provider network. Twelve Minnesota community pharmacy organizations, representing over 100 pharmacies, are engaged in the initiative. Implementation supports that help expand patient access include lists from HP identifying patients in most need of CMM interventions, a community of learning that connects participants across the initiative, frequent meetings with implementation coaches, monthly learning events (webinars), and additional strategies designed to help support expansion of patient access.

Slice of PIE will investigate research questions defined under 3 separate study aims. First, the initiative will evaluate the e‚ectiveness of the learning collaborative as an implementation strategy to drive the adoption and sustainability of CMM delivery. The second aim will be to rigorously evaluate the implementation inputs and patient outcomes of initiating the PIE program in community pharmacies. Third, the research team will determine the clinical e‚ffectiveness and sustainability of the interventions delivered by Slice of PIE participants.

This initiative has the opportunity to change the trajectory of outcomes-based care nationally, thereby allowing patients across the country access to enhanced care and better health outcomes. To learn more about the Slice of PIE initiative, including more details about the implementation strategies and the outcomes-based model, tune into the blog series regularly updated on the UMN and UNC websites.

Sign up to the communications list to receive email updates on the project, blog posts and presentations. For more information or if you have questions about Slice of PIE, please contact Lindsay Sorge, Slice of PIE Project Coordinator, at sorg0011@umn.edu.