How Two Value-Based Care Initiatives are Stretching Growth of Clinical Care Access in Community Pharmacies in Minnesota

March 24, 2021
Caity Frail, PharmD, MS, BCACP, University of Minnesota College of Pharmacy

Value-based care models in community pharmacies are advancing through exciting new channels in Minnesota. In addition to the work of Slice of PIE, the Community Pharmacy Enhanced Services Network of Minnesota (CPESN-MN) is making moves through its second cycle of the Flip the Pharmacy (FtP) initiative. Slice of PIE and FtP share some common ground, but are  distinct initiatives. They use different strategies, populations of focus, funding, and interventions toward a common goal of pushing value-based care to the next level through implementation and scale to improve patient care. So, what do they have in common, and how are they different?

What is CPESN anyway? CPESN is a "clinically integrated, nationwide organization of local networks whose participating pharmacies are accountable for the care they provide to patients." CPESN member pharmacies are diverse and offer a variety of clinical services and programs. To be a CPESN pharmacy, participants must provide at minimum the following core services:

  1. Face-to-face access 
  2. Medication reconciliation
  3. Clinical medication synchronization
  4. Immunizations
  5. Comprehensive medication reviews
  6. Personal medication record

CPESN-MN is the Minnesota network of pharmacies, including 120-member pharmacies. 

What is Flip the Pharmacy (FtP)? FtP is an implementation initiative funded by the Community Pharmacy Foundation to rapidly expand enhanced services in CPESN pharmacies in order to scale the model up. FtP involves change packages, coaching model, and funding to improve performance in six domains:

  1. Leveraging the appointment-based model
  2. Improving patient follow up and monitoring
  3. Developing new roles for non-pharmacist support staff
  4. Optimizing the utilization of technology and electronic care plans
  5. Establishing working relationships with other care team members
  6. Developing the business model and expressing value

Teams apply for selection to participate in FtP through funding provided by the Community Pharmacy Foundation (CPF). CPESN-MN’s team is now in its second cycle.

What do FtP and Slice of PIE have in common? Slice of PIE and FtP are both implementation efforts to enhance clinical care for patients in community pharmacies. Whie Slice of PIE is research-based and more targeted and focused, FtP is broader and more open. Slice of PIE is focused on most effectively providing comprehensive medication management (CMM) through community pharmacies, particularly around hypertension and diabetes. Pharmacist education, including coaching and implementation support are targeted specifically toward this goal for patients. FtP participants in Minnesota are CPESN-MN mebmers and must be ready to provide comprehensive medication reviews (CMR) as one component of the CMM patient care process, but the services advanced through FtP are much broader and not focused solely on CMM. This figure describes the similarities and differences between the two initiatives:

Venn diagram comparing FtP and Slice of Pie

Who is participating in these initiatives? Most importantly, participants are MN community pharmacists who are advancing clinical initiatives for patients in the community setting and supporting a higher level of care, and greater access to care. Not all CPESN-MN sites have opted to participate in FtP. Many of the same sites and pharmacists are participating in CPESN-MN, FtP, and Slice of PIE, including independently owned pharmacies and regional chains. This Venn diagram demonstrates how pharmacists can participate in some or all of these programs:

Venn diagram of CPESN-MN, FtP, and Slice of Pie