Success Stories

Kevin Day, president of Day's Pharmacy in Cincinnati and CPESN® Ohio's Managing Network, says network pharmacies delivered strong results in closing 2024 care gaps for CareSource patients. He points to the value-based care arrangement, along with fair dispensing, and reasonable fee-for-service programs within medical billing as wins for Medicaid patients and network pharmacies.

Payment for patient encounters to address gaps in care allows CPESN Iowa community pharmacists more time for direct care that improves health outcomes. Tammy Bullock and Fabi Gallardo, pharmacists at Osterhaus Pharmacy in Maquoketa, IA describe how their team approach under the program helped a legally blind patient better manage his medications.

Abbi Linde, CPESN Wisconsin Managing Network Facilitator, shares tips for maximizing grants that do not allow use of funds for patient services. Creativity in applying for and writing grants has helped that network secure administrative funds, as well as support for program implementation, training, and documenting best practices.

UHC Medicaid patients receive same-day care, including physician visits; and expanded billing pays the pharmacy for the health services care the patient needs. Carley Moses, a pharmacist at Peoples Pharmacy in Norfolk, VA, shares how the program is benefiting the CPESN Virginia pharmacy and its patients.

For a second year in a row, Maryland pharmacists met their goals for patient encounters as part of a HEDIS care gap closure program with Elevance/CarelonRx. That's just one success for CPESN DMV - the first regional multi-state network - as shared by Managing Network Facilitator Dixie Leikach in this short video.

CPESN Northeast Tennessee pharmacies last year completed more than 3,500 combined flu (1,175) and fall (2,374) risk assessments for Emergent ACO patients. Rebecca Wagers, Managing Network Faciltator, says the assessments are much more than a means of learning whether a patient had a flu immunization or a recent fall. Watch this short video to see how pharmacies use the assessments to improve patient health and safety.

CPESN® Mississippi network pharmacies reported more than 200 encounters with 97 Medicaid plan members over just seven months. Pharmacies enrolled plan-identified asthma, ADHD, and diabetes patients in Med Sync programs and worked with health providers to drive follow up. The 2025 contract renewal is now expanding to include COPD patients.

Jenna Eccles, pharmacist/owner at Wheatridge Professional Pharmacy in Denver, describes how integrating RxE2 clinical study program steps to overall pharmacy workflow increases efficiency, patient engagement, and pharmacy non-dispensing revenue. Eccles, who is also the Managing Network Facilitator for CPESN Colorado, says having a program champion encourages pharmacies to tap into the opportunity.

Pharmacist Allysa Mack with Gibbs Pharmacy in Lebanon, TN describes how involving a Commiunity Health Worker in patient outreach for health risk assessments has increased profit for the pharmacy, and is improving care for patients.

Shannon Schultz, owner and lead pharmacist at Nebraska LTC Pharmacy, says an invitation to provide COVID vaccines to patients at the Dialysis Center of Lincoln was a success for the pharmacy, the patients, and the nonprofit. The Lincoln clinic shared its positive experience with CPESN Nebraska pharmacy with other members of the American Society of Nephrology. That groups Kidney Community Vaccination Collaborative is exploring with CPESN Health Equity an opportunity to expand the partnership model. Watch the short video to learn more.

The Elevance/Carelon Medicaid program makes it easier to postively impact patient health, says Dustin Williams, phamacy manager at Tru-Valu Drugs in Sanford, Florida. He shares an outcomes story about a patient who lowered her A1c level from 11 to 9.7 in three months.

CPESN has been named a 2024 Health Quality Innovator of the Year, an annual award presented by Health Quality Innovators (HQI). CPESN partnered with HQI in 2024 to address vaccine hesitancy and improve access in Kansas, Missouri, South Carolina and Virginia. Trained pharmacy teams leveraged community trust to provide education, increase vaccinations and close care gaps. From September 25 to October 30, 2024, 279 clinics administered 12,795 immunizations, saving over $59M in healthcare costs. Each vaccine saved $4,000 in healthcare spending, underscoring the role of pharmacy teams in improving public health.

A second two-year renewal of a medication review program for older adults is the result of CPESN Hawaii's strong overall network performance, says Dayna Wong-Otis, Managing Network Facilitator, The renewal with Hawaii Medical Services Association (HMSA) includes increases in case rates and in the network administration fees.

The expanded UnitedHealthcare Pharmacy Care Hub Program benefits rural patients, and others who may lack transportation or broadband internet service by allowing them to access telehealth visits from CPESN pharmacy locations.The program is currently available to UHC Community Plan members through CPESN pharmacies in Kansas, Virginia, North Carolina, and Florida. Alison Haas, CPESN Director of Value Based Contracting, says the program also allows pharmacy-led services including testing and treatment for minor illness, strep, or flu; as welll as MTM and patient education.

Andrew Wagner, pharmacist and owner at Eagle Grove Pharmacy, says he has seen a lot of different patient needs presented at the rural Iowa pharmacy. But a patient with a painful zip tie stuck on his tooth was a new one. Watch this short video to see how the Eagle Grove staff drew on CPESN training and a "patient first" attitutde for a positive and cost-effective patient outcome,

CPESN Ohio pharmacies are seeing new service opportunities that also expand patient access to care under the CareSource Medicaid MCO payer agreement. In additional to fee-for-service payments, pharmacies can earn bonuses based on overall network performance. Jackie Boyle, a network facilitator and Assoc. Dean, Student Success, Practice Transformation at Northeast Ohio Medical University shares benefits of the partnership.

Preliminary data for a diabetes management program with a Medicaid MCO shows that 64% of patients that engaged at least twice with CPESN North Carolina pharmacists maintained or improved their A1c values. Madeline Clark, one of the network facilitators, says participating pharmacists are excited about the opportunity to reach even more patients with an increased budget under the contract renewal.

In partnership with six regional Quality Improvement Organizations, pharmacists and their staffs in 23 CPESN® local networks adminstered nearly 40,000 vaccines to residents and staff of long-term care facilities across the country. Lindsay Christensen, CPESN Minnesota Executive Director, served as program support lead and she shares details in this short video about the more than 600 clinics that expanded access and improved safety in these care settings.

Strong engagement with patients diagnosed asthma or diabetes, and pediatric patients diagnosed with ADD/ADHD led to program renewal with Magnolia Health, the Medicaid MCO in Mississippi. Amy Catherine Baggett, managing network facilitator, says sharing patient impact testimonials and pharmacy results with the MCO also allowed expansion to include collecting HbA1c for diabetes patients.

Watch this short video to learn more about how CPESN USA's 3,500 pharmacies and 8,000 providers help health plans lower cost, while improving patient health outcomes. And see examples how payer programs are generating revenue for our pharmacies. Pharmacy owners collaborating with other pharmacy owners to generate new revenue streams.

Bob Lomenick, CPESN MIssissippi Lead Luminary and pharmacist/owner of Tyson Drugs in Holly Springs, MS, says his staff piggybacks care gap outreach with med sycn calls to schedule UHC HbA1c and blood pressure checks for Medicaid patients. He shares that and other tips in this short video. Other networks particpating in the gap closure program through Dec. 31 are CPESN Virginia, CPESN Florida, and Pennsylvania Pharmacists Care Network, the CPESN network in Pennsylvania.

Wyatt Walker, CPESN® Louisiana Managing Network Facilitator and pharmacist/owner at Walker's Drug Store in Livonia, LA, says administering COVID-19 at four nursing homes turned a profit of about $20K for his store. The vaccines were administerd under the CPESN partnership with Alliant Health Solutions, a Quality Improvement Organization.

Increased pharmacy engagement with a Medicaid MCO population is the goal for CPESN® North Carolina pharmacies participating in a renewed diabetes management program. Clinical services being provided under the contract med sync and other efforts to increase adherence, as well as regular monitoring of glucose levels. Laura Rhodes, Managing Network Facilitator, hopes the deeper patient engagement and refreshed data will lead to another renewal for 2025.

Dayna Wong-Otis, CPESN® Hawaii Managing Network Facilitator, describes the network's newest payer program with MDX Hawaii. Pharmacies on three of the Hawaiian islands will work with patients enrolled in Medicare Advantage programs to help close adherence gaps associated with STAR measures. The payer has already expressed interest in additional pharmacy services.

Patient trust allows community pharmacists in Tennessee's two networks to complete Health Risk Assessments with UnitedHealthcare's hard-to-reach members. Amber Suthers, CPESN Tennessee, Managing Network Facilitator, says it's rewarding to see payers recognize community pharmacy's value in caring for patients. The program is open to all CPESN Tennessee and CPESN Northeast Tennessee pharmacies.

Inpatient admissions were 33% points lower for high-risk Medicaid patients engaged with CPESN community pharmacists during a pilot outreach program, compared with those members not reached by local pharmacists. Results of the claims data lookback study are reported in research released by the Elevance Health Public Policy Institute. Lindsey Ludwig, CPESN Iowa Executive Director, describes the impact of the two-year program in this short video. Elevance Health/CarelonRx currently has programs in 11 CPESN networks with plans to add more this year.

Strong performance by CPESN Minnesota pharmacies statewide led to an expanded UCare Minnesota contract. The gap closure program has been expanded to 16 areas of care, including five care coordination measures.

The Corporation for Ohio Appalachian Development (COAD) has expanded its Pathways program statewide, opening opportunities for CPESN pharmacies to receive and make care coordination referrals through county and regional HUBs. Pharmacies need to train or hire certified Community Health Workers and complete a credentialing process. Medicaid is the primary payment source for CHW services.

CPESN® USA has partnerships with six regional Quality Improvement Organizations for pharmacies in 23 networks to help long-term care facilities increase current COVID-19 vaccination rates for residents and staff. Cindy Warriner, a CPESN Virginia facilitator, and a senior pharmacist consultant with Health Quality Innovators, says the partnerships showcases for all federal health decision makers the value that community pharmacy brings to 65+ patients.

Laura Rhodes, CPESN Florida Managing Network Facilitator, says the network is off to a strong start with pharmacy outreach to close care gaps for plan-identified Medicaid patients.