Leveraging Community Pharmacies to Improve Medicaid Access, Outcomes and Cost Management
Medicaid Agencies are constantly exploring innovative strategies to drive more positive outcomes, expand access to care, and better manage rising costs. Community pharmacies have emerged as valuable and accessible points of care for Medicaid members. By leveraging the expertise and accessibility of pharmacists, Medicaid agencies can significantly expand access to care, positively impact the management of chronic conditions, and close critical care gaps among their members.
The Challenge: Uncontrolled Chronic Conditions in Medicaid Populations
Chronic conditions like diabetes and hypertension pose significant and costly challenges to Medicaid programs. These conditions disproportionately impact low-income populations and often go unchecked. Let's look at the numbers:
- Approximately 15% of all Diabetics in America are Medicaid members with many unaware of their condition1.
- About 33% of the entire Adult Medicaid member population are believed to have hypertension2 and low-income, non-pregnant Adult Medicaid members have higher rates of uncontrolled hypertension3
Millions of Medicaid members need help managing these and other conditions and navigating a complex healthcare system. This is where community pharmacies can play a pivotal role in helping Medicaid agencies better document, manage, and deliver care; improving access and health outcomes for Medicaid members across the nation.
The Solution: Pharmacy-Based Interventions for Medicaid Members
Community pharmacies offer a unique opportunity to address these challenges in Medicaid populations:
- Accessibility: Pharmacists are often the most accessible healthcare professionals for Medicaid members. In a time where primary care continues to be in short supply, they represent an opportunity to expand access and also reduce reliance on primary care physicians. In the United States, almost 90% of people are within a 5-mile radius of a pharmacy4
- Expertise: Pharmacists can identify drug interactions and help optimize treatment plans, crucial for Medicaid members who may have complex health needs and goals to achieve more positive outcomes.
- Trust: As trusted community figures, pharmacists can effectively engage Medicaid members in their health management and improve members' activation into care.
Evidence-Based Impact: Closing the Blood Pressure and Blood Sugar Control Gaps
Recent research shows that pharmacist-led interventions can result in significant improvements in blood pressure and blood sugar control, particularly beneficial for Medicaid members who may have limited access to primary care. Pharmacists can:
- Educate Medicaid members about their medications, healthy lifestyle choices, and condition management.
- Monitor blood pressure and blood sugar levels to identify potential issues early on.
- Review medication regimens to identify potential interactions or gaps in treatment.
- Work with physicians to recommend medication adjustments or address medication adherence concerns, critical for Medicaid members who may face barriers to care.
Collaboration is Key: Pharmacists, Physicians, and Medicaid Agencies Working Together
When pharmacists and physicians collaborate, Medicaid members receive more comprehensive and coordinated care. This collaboration can lead to:
- Improved blood pressure and blood sugar control among Medicaid populations
- Reduced risk of complications associated with chronic conditions
- Enhanced patient understanding of their condition and medications
- Reduced health disparities are often seen in Medicaid populations
Improving Cost Management
Investing in pharmacy partnerships can lead to significant cost savings for Medicaid programs:
- Reduced hospital admissions and readmissions due to better chronic disease management
- Lower medication costs through improved adherence and optimized treatment plans
- Decreased emergency department utilization for manageable conditions
- Mitigating risk for potentially avoidable conditions associated with chronic conditions
Implementation Strategies for Medicaid Agencies
To leverage community pharmacies effectively, Medicaid agencies can:
- Incentivize Pharmacy Services: Develop reimbursement models that reward pharmacies for providing clinical services to Medicaid members and improving health outcomes.
- Data Integration: Implement systems to seamlessly share member data between pharmacies and other healthcare providers within the Medicaid network.
- Collaborative Care Models: Establish formal collaborations between pharmacists, physicians, and other healthcare professionals serving Medicaid populations.
- Patient Engagement: Educate Medicaid members about the expanded services available at their local pharmacies.
- Quality Strategies: Incorporate pharmacy-based interventions into Medicaid quality improvement initiatives and performance metrics.
Conclusion
By leveraging the accessibility, expertise, and community presence of pharmacists, Medicaid agencies can expand access to care, enhance chronic disease management, improve outcomes, and ultimately reduce healthcare costs.
As we move towards a more integrated and patient-centered healthcare system, partnerships with community pharmacies will be crucial in achieving Medicaid's goals of better health outcomes, mitigated health disparities, improved cost management, and more accessible and efficient healthcare delivery for vulnerable populations.
To learn more about how your organization can leverage pharmacy partnerships to close care gaps and improve outcomes, download our free PQS by Innovaccer brochure by filling out this form.
2,3https://www.ama-assn.org/system/files/issue-brief-medicaid-smbp.pdf
4https://www.japha.org/article/S1544-3191(22)00233-3/fulltext
