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    Performance-based pharmacies improve Medicare beneficiary health

    Medicare beneficiaries with diabetes, high blood pressure or high cholesterol may achieve better health outcomes when using pharmacies that are part of performance-based networks, according to early results of a pay-for-performance program conducted by SCAN Health Plan and Express Scripts.

    Sharon JhawarJhawarPharmacists are said to be one the most trusted of all healthcare professionals and their frequent interactions with members present opportunities to positively impact patient health, according to Sharon Jhawar, vice president of pharmacy services at SCAN.

    “The Medicare space is challenging, competitive and complex,” says Jhawar. “Centers for Medicare and Medicaid Services’ ratings are a moving target, and plan quality is directly tied to patient health outcomes. Plans can only impact patient behavior so much. Therefore we need to partner and align all of the parties on that patient’s care team—pharmacists, nurses and physicians—to truly have an impact. The Quality Network Program and its value-based network design was a logical next step for our plan, and as these results demonstrate, is having a positive impact on patient health.”

    Related: New model for managing specialty pharmacy aims to improve quality at reduced cost

    Leveraging actionable data and clinical experience from its Therapeutic Resource Centers, Express Scripts works collaboratively with each pharmacy participating in the two-phase Quality Network Program to review and improve their patients’ performance in five key areas: reducing the use of high-risk medications, compliance with diabetes treatment guidelines (use of high blood pressure therapy in diabetes patients), and greater adherence to diabetes, high blood pressure and high cholesterol medications.


    NEXT: Phase II


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