Jeff Church
Blue Cross and Blue Shield of Alabama is partnering with APCI member pharmacies in the state to expand its medication adherence program following a successful pilot which began late last year.
The goal of the program is to take a selection of Blue Cross’ Medicare Advantage patients who are non-adherent with their medications in three specific areas – diabetes, hypertension, and cholesterol – and move them to 80 percent or better adherence.
The pilot program, conducted between October and December of 2017, saw success in increasing adherence rates in a select group of patients. In that program, adherence rates improved for 69 percent of the patients, with 36 percent becoming adherent to their medications.
“It was definitely advantageous to have our pharmacists get involved with patient care,” said Jeff Church, APCI’s Manager of Professional and Clinical Affairs. “Blue Cross was very satisfied with the results and wants to continue the program.”
The 2018 program is expanding the number of patients and participating pharmacies in the effort. This year, 326 Alabama pharmacies are taking part working with almost 2,700 patients. Additionally, some patients who were in the pilot program are also included this year.
“The patients were all chosen by Blue Cross,” Church said. “The idea is to continue to track these patients so they stay adherent. We don’t want to get them adherent and then lose focus, allowing the patient to become non-adherent. We want to keep them adherent. Continuing this focus on adherence will help keep the patient healthy and reduce hospital admissions.”
APCI member pharmacies took part in a series of eight training webinars in June to kick off the program. Staff from both APCI and its technology partner, PrescribeWellness, will work with various programs to assist the pharmacies throughout the effort. Additionally, a monthly scorecard will be provided that will rank the pharmacies against their peers to drive performance.
Blue Cross and Blue Shield of Alabama will pay each member pharmacy $100 per patient for reaching the established medication adherence rate for the first adherence measure and an additional $25 for each of the other two adherence measures.
A fourth measure, statin use in patients with diabetes (SUPD), is being added to the program this year. This new program measure calculates the percentage of patients who received at least two diabetes medications and have also received a statin medication during the measurement period. Payment will be $50 per patient who has one fill of a statin medication during the measurement period.
“SUPD will be a triple-weighted measure next year with CMS, so we’re proactively getting the stores to start focusing on those patients,” he said. “If they are a patient with diabetes and they are not on a statin, we are trying to initiate that therapy with their doctor.”
“The success of the adherence program could lead to other similar opportunities with other payers,” Church said. “If you can get patients adherent, you’re improving their health and reducing hospital admissions. I think they would want to be part of that,” he said.