College convenes health care plan and provider discourse

Minnesota is ahead of the game in these collaborations.

Since November 2021, the College of Pharmacy has served as the convening point for structured dialogue between Minnesota health care plans and pharmacy providers. 

The work was sparked by a regional health plan’s request that the college host an initial conversation among pharmacy leaders from health plans. After preliminary discussion demonstrated health plan representatives were engaged with each other, the scope of conversation expanded to include pharmacy leaders from health systems and community-based pharmacy programs. Bridging language between the needs of pharmacists providing care and pharmacists working at health plans was also important prior to hosting larger discussions.   

“We learned from that experience, when we designed what became our series of plan-provider summits,” said Dr. Sarah Westberg, associate dean for professional affairs. “Having a couple meetings with just the plans helped us be better facilitators of that conversation across those stakeholder groups, to understand where the plans were coming from, build that trust and rapport with each other, some of which they were doing on their own.”

The college helped form small work groups that create more collaboration between pharmacist providers and health plans. One group is launching a continuing education course designed by pharmacist providers and plans on service delivery, sustainability, and payment. Another focuses on establishing consistency across health plan expectations for care documentation, credentialing, and billing. On a larger scale, the college has accomplished bringing health plans and providers into the same room and fostered a working relationship between them, said Dr. Todd Sorensen, senior executive associate dean for strategic initiatives and faculty affairs. 

“We should be really pleased and proud about it, because it's not this way in most states,” Sorensen said. “We've got the providers and health plans talking to each other, learning from each other, and understanding each other's perspectives in ways that certainly didn't exist before.”

For example, the plans and providers have been communicating about CPT codes, billing, and defining services. They’re progressing at a faster rate, now that they’re working together to align their outcomes. This could make a difference for Minnesota in terms of implementing changes around the new legislation, Sorensen said, since there’s already established relationships and work happening between providers and plans. 

“I can confidently say there's things that are happening here smoother, faster, and with better understanding than in other states that may have a similar environment… Mostly because they don’t have a place to convene,” Sorensen said. 

The relationships formed between individuals during these conversations will make a difference in ways “difficult to quantify,” Westberg said, and may be reassuring to community and clinic pharmacists wondering if health plans care about their patients. 

“The impact of that is it's so helpful for a pharmacist sitting in their community pharmacy who wants to do more or is struggling with some sort of barrier— getting credentials, getting billing— now they know a person at the plan that they can connect with,” Westberg said. “That's so much easier than calling some general credentialing number and getting pushed through a bunch of people who don't know what you're talking about.”

With the start of 2025, the new legislation concerning payment for pharmacy services went into effect. This has shifted the tone of these payer-provider conversations. Where advocates previously focused on better implementing resources to encourage health plans to expand their coverage of services, a law now requires that coverage for commercially insured beneficiaries, though for Medicaid recipients, that coverage has been in place since 2006. Now, it’s more about working out the hiccups. For instance, health plans and attorneys may have varying interpretations of the law and to which plans it applies. Westberg also noted that several more work groups may emerge with the new legislation.

“I would say our conversation shifted quite a bit, but the design of how we facilitate the conversation…those kinds of structure pieces are the same,” Westberg said. “The calendar changed and the date of effectiveness came around, but the reality is, nobody's really ready for it, so there's still a lot to be done…those implementation barriers will probably take years to sort out.”

The college’s focus remains on convening and improving health outcomes at the state level, though Minnesota may serve as an example on a national scale. One way this happens is through the Align Summits hosted by the college, which convene stakeholders across the country to learn from one another about payer-provider collaboration. Much of the meaningful work in this sphere occurs at a local level through regional plans, but these national conversations can inspire other states to replicate Minnesota’s best practices and shift overall opinion on the potential of providers working with health plans. 

“The structure, the conversation, that’s one piece— it's the framework for advocacy for more changes. But I don't want to lose touch with the fact that locally in Minnesota, we all share a goal that citizens in Minnesota in need of pharmacist services can access it at a place of their convenience,” Westberg said. “Consistency for our people, our communities across health plans is really beneficial for patients and for our profession, too.”