This guest blog is one in a series by sponsors of the 2023 PQA Leadership Summit on EQUIPP enhanced services. The views shared in this series are those of the author and do not reflect any PQA positions.
In 2023, more than 50 million patients were enrolled in a Medicare Part D prescription drug plan to support their health outcomes (kff.org). Currently, the US has over 60,000 pharmacies that serve as vital connectors between providers and patients (commonwealth). The enduring success of pharmacies can be supported by the availability of financial opportunities that not only benefit the pharmacies but also contribute to positive patient health outcomes.
Pharmacy Quality Solutions (PQS) has launched Enhanced Services as part of the EQUIPP® platform, specifically designed to support pharmacy clinical services and revenue-generating pathways. Supported by our health plan partners, Enhanced Services focuses on identifying patients with care gaps that can be addressed by a pharmacy. Programs within Enhanced Services, such as Controlling Blood Pressure (CBP) and Hemoglobin A1c, aim to bridge clinical gaps and improve medication adherence with the help of pharmacy clinical services. Pharmacists are able to provide health screenings and additional monitoring to these patients. Currently, these programs represent over $11 million worth of revenue opportunities.
The emphasis on the pharmacy-member connection within the EQUIPP program allows health plans to harness the strength of pharmacies for patient engagement and data collection. This approach enables health plans to obtain necessary blood pressure and point-of-care test results to facilitate treatment of care gaps. EQUIPP is currently accessible to 95% of community pharmacies, and the platform offers patient opportunities for pharmacies to make an impact to patient lives in their communities. Furthermore, pharmacies engaging in these programs can enhance quality measure performance scores, contributing to improved patient outcomes.
To kickstart this collaborative effort, health plans can incentivize pharmacies to provide clinical services. Given that 68% of Medicare-eligible patients deal with two or more chronic diseases and may need assistance in closing their gaps in care (CDC), incentivizing pharmacies to earn additional revenue becomes crucial to providing support for chronic condition patients. Participating pharmacies can perform blood pressure checks and A1c screenings, utilizing the Enhanced Services capability in the EQUIPP platform to collect and deliver the data back to the health plans. Subsequently, health plans can coordinate with the patient’s providers to develop strategies for better management of population health outcomes. This integrated approach incorporates the pharmacy and enhances the overall quality of care for patients dealing with care gaps and chronic conditions.
Brittany Boyd is the Senior Manager of Pharmacy Training and Support at PQS working directly with corporate pharmacy organizations and independent pharmacies to improve their performance on medication-related quality measures. She is a Certified Pharmacy Technician with 12 years of diverse pharmacy experience directed towards patient care and quality performance success. Boyd holds a Master’s Degree in Healthcare Administration and incorporates her education with knowledge of the pharmacy industry to support strategic initiatives related to performance improvement. She has been with PQS for 5 years engaging with pharmacies to develop tactful, timely, and results-focused plans through utilization of the EQUIPP platform.
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