A year ago, Value Pharmacists introduced our readers and members to the Community Pharmacy Enhanced Services Network (CPESN®). The CPESN concept was expanding across the country. At the time of the blog post, CPESNs had launched in 15 states and were at various stages of planning in 30 others with emerging or active networks. Many of you have been asking what’s been happening in all these networks so here is the latest CPESN news:
- There are currently 35 states with a CPESN.
- CPESN USA is now a clinically integrated network.
- Pharmacist E-Care Plan rollout in Fall 2018
Before we look at each of these developments in more detail, here is a brief re-cap on CPESN and CPESN USA. CPESN originated in North Carolina (NC) where pharmacists worked together with other health care providers to provide coordinated care through the medical home model, Community Care of North Carolina (CCNC). CCNC employed pharmacists to help with optimization of medication use, including the embedding of pharmacists in primary care offices, long term care facilities and hospitals, however, there was no formalized relationship with local community pharmacies. This is how the NC CPESN began. The NC CPESN was developed as an open network, allowing all pharmacies to participate who were willing to meet the established minimum criteria, deliver enhanced services and document interventions.
After the formation of the NC CPESN, CCNC received a 3 year grant of 12 million dollars from the Center for Medicare and Medicaid Innovation (CMMI) to test payment reform in community pharmacies for Medicare, Medicaid, dually eligible Medicare-Medicaid, and NC Health Choice beneficiaries by using a collaborative care model where community pharmacy was part of the medical home team. By 2014, 246 North Carolina pharmacies were committed to the CPESN approach of active integration of pharmacist activity with other health care providers of the Patient Centered Medical Home.
In September 2015, CCNC launched the Multi-State High-Performing Community Pharmacy Collaborative (MSPC) to facilitate the expansion of additional high-performing CPESNs nationally. Through this collaborative, pharmacies and organizations and existing pharmacy networks and state pharmacy associations pursued the development of additional CPESNs nationwide. The nationwide expansion was supported by joint collaboration between CCNC and the National Community Pharmacists Association (NCPA) resulting in the formation of CPESN USA.
There are currently 35 states with a CPESN
Every pharmacy in the state CPESNs must be a member of CPESN USA. The networks are free to set up their organizational structure as they determine will be most beneficial to their health care partners and patients. Here are a just a few examples of the creativity utilized by some networks and their participating pharmacies:
Academy of Independent Pharmacy for the Georgia Pharmacists Association or AIP-GA CPESN – Multi-store pharmacy owner Charlie Barnes is the network facilitator and he and his staff are running 4 separate pilot programs, including one with United Healthcare, to gather and analyze patient data and share the pharmacy’s impact with payers, physicians, ACOs and self-insured businesses. The AIP-GA CPESN currently has 189 pharmacies in the network and participation continues to increase.
CPESN Tennessee and the Tennessee Pharmacists Research and Education Foundation, a direct subsidiary of the Tennessee Pharmacists Association, is partnering with Amerisource Bergen to launch a readiness program that allows for 70 CPESN Tennessee participating pharmacies to provide Congestive Heart Failure (CHF) interventions. The readiness program, which kicked off August 1, 2018 is designed to test and validate a scalable roadmap for pharmacists, payers and other providers to engage in a consistent model of community pharmacist-provided services for CHF.
CPESN NC is testing a per-member per-month payment model based on the severity of the patient risk and a performance score. The adjustment for the risk score of the patient should help ensure the pharmacy is paid more for working with more complex patients because that activity is more time-intensive.
Pennsylvania Pharmacist Care Network (PPCN) launched its first contract with a Medicaid Managed Care Organization payer in Summer 2017. There are 161 individual community pharmacies within PPCN, 138 of which are independently owned, and 23 individual pharmacies from two regional chains.
Since their first kick-off meeting in November 2016, the Arkansas CPESN now has 141 participating pharmacies.
For a complete listing of the CPESNs, please go to www.cpesn.com.
CPESN USA is now a clinically integrated network
The definition of a clinically integrated network (CIN) is a “collection of health care providers that demonstrates value to the market by working together to facilitate the coordination of patient care across conditions, providers, settings, and time to improve patient care and decrease overall healthcare costs.” The clinical integration network (CIN) is the actual legal entity/network that the health care providers must join. By being part of a clinically integrated network, participating pharmacies can engage with each other and contract with other entities, such as insurance companies and government health programs. The Federal Trade Commission has a number of criteria to be classified a CIN and all these criteria need to be met so there are no antitrust implications. CPESN USA is using outside counsel to continually review the organizational structure and goals and to ensure that CPESN USA meets all of the criteria of a clinically integrated network.
Pharmacist E-Care Plan rollout in Fall 2018
The Pharmacist eCare Plan includes a shared document detailing a patient’s current medication regimen and health concerns, including drug therapy problems and medication support needs, in addition to the pharmacy’s interventions and the patient’s health outcomes over time. The Pharmacist eCare Plan standard, designed to improve outcomes related to medication use and coordinated with other care team members, will allow pharmacists to create care plans within the technology already in use in the pharmacy and utilize existing standards for data exchange between providers, government agencies, the vendor community, and patients. This standard way of sharing pharmacist-provided clinical data will give pharmacists a way to validate their services for their quality-based payment models. 25 technology vendors are participating in the Pharmacist eCare Plan and pharmacist training for the Pharmacy E-Care Plan has already begun so some CPESNs may be able to utilize the program in the fall of 2018. For more details about the Pharmacy E-Care plan, including the list of technology vendors, please go to https://cpesn.com/ecare-plan/ .
As you can see, there are many new and exciting developments at CPESN USA. Value Pharmacists will continue to provide updates. CPESN USA is hosting informational sessions that are open to anyone. They are scheduled for the 4th Thursday of every month at 7 p.m. EST. Up next is Thursday, September 13, 2018. Click to register or to see future scheduled sessions!