Community Pharmacy Enhanced Service Network (CPESN®) now in Minnesota

Community Pharmacy Enhanced Service Network (CPESN®) now in Minnesota
Alison Kingsbury, PharmD, GuidePoint Pharmacy

Background: This past September, 31 community pharmacies founded Community Pharmacy Enhanced Services Network (CPESN) Minnesota. Striving for a higher level of care, CPESN is an integrated network of community pharmacies that coordinate patient care to provide medication optimization activities and enhanced services. Enhanced services of community pharmacies in CPESN may include: face-to-face access for patients, medication reconciliation, clinical medication synchronization, comprehensive medication reviews, personal medication records, collection of vital signs, tobacco cessation program, point of care testing, administration of long-acting injectables, naloxone dispensing, and nutritional counseling. 

In 2014, the first Community Pharmacy Enhanced Services Network was initiated when the Community Care of North Carolina (CCNC) established the first network in North Carolina; capitalizing on community pharmacies regular encounters with those in the community requiring a higher level of care. North Carolina Medicaid claims, according to CCNC, revealed patients with the most need of medication-focused care coordination visit the pharmacy more than thirty-five times annually contrasted to three and a half visits to their primary care provider. Increased patient encounters enable community pharmacies to grow to be an integral part of health care teams to improve patient outcomes.

Evidence: Community pharmacies influence outcomes associated with reducing readmissions to the hospital, enhancing the value of medication, and improving patient satisfaction. Per a CCNC performance analysis of CPESN North Carolina, high-risk Medicaid patients working with their primary care provider and supported by a CPESN pharmacy were: 45% less likely to have an inpatient hospital admission; 35% less likely to have preventable hospital admission or readmission; 15% less likely to an emergency department visit; 25% more likely to engage their primary care provider; and 20% more adherent to medicine. Primary care underwent change to outcomes-based reimbursement by creating Accountable Care Organizations (ACO) and now pharmacy, through CPESN, is striving to create accountable pharmacy organizations. With health care shifting to outcomes-based reimbursement, CPESN’s emphasis on enhancing patient outcomes align with other members of the health care team.

Enhanced services in the community pharmacy have also demonstrated to reduce health care costs. Towncrest Pharmacy, a pharmacy in CPESN Iowa performed a pilot study with a payor to illustrate the cost benefit of patients utilizing a pharmacy with enhanced services. Over a one-year period, total health care costs were compared between patients that utilized Towncrest Pharmacy for: all prescriptions, about 50% of prescriptions; or do not fill prescriptions at Towncrest Pharmacy.  The patients that filled all prescriptions at Towncrest Pharmacy used $298 and $309 less than those who do not fill at the enhanced services pharmacy (N=546, P<0.0001) and who filled 50% of the time at the pharmacy(N=340, P<0.0012), respectively. Demonstrating lower health care costs when patients utilize an enhanced service pharmacy incentivizes payors to change the pharmacy reimbursement model. 

Clinical Impact: CPESN Minnesota has embarked on a two-year grant with other states’ CPESN to transform pharmacy practice to focus on enhanced services.These pharmacies aim to demonstrate the benefits of community pharmacies’ outcomes on a large scale. Pharmacies document the outcomes through care plans to demonstrate to payors the benefit of an accountable pharmacy organization. CPESN Minnesota endeavors to create new practice of community pharmacy that is an integral part of the healthcare team.

 

References:

  1. CPESN. CPESN.com/payors. Published 2018. Accessed November 19, 2019. 

  2. Community Care of North Carolina. https://www.communitycarenc.org/. Published 2019. Accessed November 19, 2019. 

  3. McDonough R. Making the Business Case for Enhanced Medication Management Strategies [webinar]. Iowa: Center for Health Care Strategies; 2019.