L.A. Care Health Plan, Inland Empire Health Plan Team Up on Pharmacist Provider Program
As COVID-19 continues to impact the Southern California region, L.A. Care Health Plan and Inland Empire Health Plan (IEHP) are announcing their partnership in the California Right Meds Collaborative (CRMC), a pharmacist-led initiative founded at USC last year, consisting of health plans, pharmacies, academic and professional organizations that aim to deliver high-impact comprehensive medication management through a value-based payment model.
Pharmacists in the California Right Meds Collaborative program provide clinical services to Medi-Cal, Medicare and Covered California patients in Los Angeles County and the Inland Empire who have persistently uncontrolled health conditions like diabetes, high blood pressure and asthma. L.A. Care Health Plan and IEHP – which together serve over 3 million members – provide payment to participating pharmacists based on accomplishment of treatment goals, officials noted in a recent announcement on the partnership.
With more than 90 percent of the U.S. population within 5 miles of a pharmacy, pharmacists are in a key position to play a greater role in managing diabetes, obesity, high blood pressure, asthma and other chronic disease conditions that greatly increase the risk of hospitalization and death from COVID-19, they added.
“By leveraging community pharmacies as neighborhood-based health hubs, patients who struggle with chronic disease control have easy access to Comprehensive Medication Management, a service that optimizes medication therapy,” said Steven Chen, PharmD, associate dean for clinical affairs at the USC School of Pharmacy, who founded the program. “The California Right Meds Collaborative, focusing on population health priorities, allows pharmacists to collaborate with physicians to fully utilize their training for the benefit of patients, physicians and health plans and the community.”
For example, diabetes patients referred to participate in the L.A. Care California Right Meds Collaborative pilot program meet regularly with their pharmacist in-person or through telehealth visits for Comprehensive Medication Management, which includes evaluating all medications and making changes or recommendations in partnership with the patient’s physician. Organizational leaders offer a story of one specific patient who was told by a physician that her 20-year history of uncontrolled diabetes put her at high risk for hospitalization and possible amputations. The patient began meeting with her local pharmacist via video-chats, learning how to change her eating habits, exercise, monitor her blood sugar levels consistently and regulate her medications. Today she is meeting the health goals set by her physician.
Indeed, through the program, patients receive education and counseling on proper medication use and self-management, and they receive extensive monitoring for efficacy/safety and dose adjustments. Pharmacists can also alert doctors if problems come up or the patient’s health doesn’t improve, officials explain.
Many of the pharmacists selected to participate in the California Right Meds Collaborative pilot program say the initiative is giving them a way to leverage their training and contribute to the health of their local community. “Pharmacists have so much to offer in improving health outcomes,” said Dr. Annie Thai of 986 Pharmacy. “We can spend time counseling patients to make sure they are adhering to their medication regimen, and we can make sure the doctor, patient, the whole team is in line with each other. That’s a win for everyone—patients, physicians, pharmacists, the community—particularly in this time of COVID-19.”
Meanwhile, physicians who partner with pharmacists in the collaborative can benefit in many ways, too. The shortage of primary care providers has made physicians busier than ever, with limited time to address the medication-related needs of patients. In addition, physician payments today are frequently tied to the disease control status of their patients such as blood pressure or asthma control. Through the California Right Meds Collaborative, incentives are aligned to put the patient’s needs first, allowing patients to spend time with pharmacists to optimize medication therapy leading to increased physician, availability/access, and satisfaction, officials noted.
CRMC leaders also believe that an alignment between health plans and providers is essential to fiscally sustainable model of care, and are actively engaging health plans and systems to develop a value-based payment structure to enable community pharmacies to provide CMM services. L.A. Care Health Plan, Inland Empire Health Plan, and the Los Angeles County Department of Public Health are key partners of the CRMC today.
“As the country’s largest publicly operated health plan, L.A. Care recognizes the expertise and value pharmacists provide as an integral part of the healthcare team,” said John Baackes, CEO of L.A. Care. “By pioneering a value-based payment program that engages community pharmacists, California Right Meds Collaborative connects patients with the most accessible and trusted health care providers right in their own neighborhoods.”
