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How Community Pharmacies Enable Health Plans to Measurably Improve Adherence and Quality Measures

Medication adherence has a wide-reaching impact on the healthcare industry – from hospitals, to pharmacies to health plans, no area is unaffected. The estimated annual cost of medication nonadherence alone is over $290 billion, contributing to more than 10% of the total national healthcare spending.

For health plans, nonadherence among their members is a major problem, leading to worsening health outcomes and higher medical costs. Member nonadherence also negatively effects health plan scores on quality measures, which can result in lower Star ratings. Ultimately, the health plan’s profitability can take a big hit as a result of nonadherence.

The Community Pharmacist: A Key Partner Helping Health Plans to Improve Quality Scores

So, how do health plans ensure that their members remain adherent and healthy, while achieving significant improvements in quality measure scores and associated ratings? A powerful answer can be found in every community in America: the neighborhood pharmacy.

For health plans, the community pharmacy can be an important partner in solving the adherence problem and contributing to increased quality scores and higher Star ratings. For starters, the pharmacist has more face-to-face interaction with patients than any other healthcare provider. Pharmacists see a patient an average of 33 times a year versus primary care physicians who only see that patient 3 times a year.

Because pharmacists are seeing and following up with health plan members on a monthly, or even weekly, basis, they are well positioned to have a very positive effect on medication adherence, which is a prerequisite to achieving positive health outcomes and improving profitability. 

“The fact that members are being seen and followed up with on a monthly basis by their neighborhood pharmacist, is key to driving adherence and improving health outcomes,” said Bjorn Thommesen, Client Success Executive at EnlivenHealth™. “For health plans, this improves revenue flow from repeat premiums, while also reducing costs associated with hospitalizations and ED visits.”

Achieving consistent medication adherence is obviously an essential part of keeping patients and plan members healthy. So, how do pharmacists ensure medication adherence in practice? Technology is a critical part of the equation. Pharmacies today are implementing a range of proven, powerful technology solutions that help automate and streamline traditional, time-consuming tasks related to dispensing and administration. This frees up pharmacists’ time to practice at the top of their license, spend more time with patients, and expand their operations to feature value-added services such as vaccine administration, point-of-care testing and medication therapy counseling.

One of the leading technologies that has become a key tool for retail pharmacies in ensuring patient adherence is medication synchronization, or Med Sync. This appointment-based technology coordinates a patient’s prescriptions to a single refill date once a month. Med Sync ensures that patients always have the medications they need on hand, which plays a major role in driving adherence. In addition, Med Sync frees up the pharmacist’s time because of the significant decrease in patient phone calls and pharmacy visits. In addition to giving the pharmacist more time to focus on value-added services that improve patient health outcomes and drive script growth, Med Sync improves the patient experience, which helps to increase retention.  

Of course, healthier, happier patients are also healthier, happier health plan members. Power adherence technologies like Med Sync enable health plans to achieve better quality scores, higher Star ratings and, ultimately, better profitability.  It’s no wonder that health plans are increasingly partnering with retail pharmacies to leverage advanced technologies like Med Sync to help keep their members healthy and happy.

The EnlivenHealth™ Difference

With its nationwide network of more than 30,000 pharmacies, EnlivenHealth™ plays a significant role in enabling this win-win partnership between health plans and pharmacists. EnlivenHealth™ manages a range of high successful national programs that allow health plans to target their members who are patients of those 30,000+ pharmacies and ensure that that they achieve adherence.

The technology that makes all of this happen is EnlivenHealth’s industry-leading Medication Synchronization solution. Through these health plan programs, EnlivenHealth™ has created new contracts connecting pharmacies to pay-for-performance revenues that support pharmacy business results, improve patient health outcomes and lower overall healthcare costs.  Again, it’s a win-win for the health plans, the pharmacies and, most important, the patients/members.

“The heart of the EnlivenHealth™ technology supports the direct interaction between the pharmacist and health plan member,” says Irfan Ali, Senior Director – Network Performance, EnlivenHealth™. “It’s that vital human touch element from the pharmacist, who is involved in the longitudinal care of the member. Solutions like EnlivenHealth™ Med Sync and our new Personalized Communications solution, enable pharmacists to ensure longitudinal interaction and care over time at the pharmacy – building the type of relationships that health plans value and that drive better health outcomes.” We invite you to learn more about the EnlivenHealth™ Medication Synchronization and Personalized Communications solutions and how they can benefit your members by speaking with a member of the EnlivenHealth™ team.