The understated value of independent community pharmacies within value-based care

Perspective: Insights-driven outcomes | Capability: Pharmacy | By: Carelon

Independent pharmacies have become key frontline contributors to value-based care models. Rooted in their local communities, they can provide personalized care that improves patient outcomes and lowers costs.

What if quality healthcare didn’t mean higher spending, especially on treating chronic diseases? Such is the promise of progressive value-based care models that tie in pharmacy. These new, patient-centric approaches to value-based care can lead to reduced spending and improved health outcomes.

One increasingly key player in these models is independent community pharmacies. Constituting about 35% of retail pharmacies , these pharmacies are uniquely accessible to deliver what’s become more challenging to offer: affordable, personalized care for members with high needs.


An opportunity for more impactful pharmacy care


Innovators at healthcare organizations are exploring new care models for their members with high risks or needs. For many of these models, pharmacies are near the center of them, and for good reason: High-risk individuals average 35 pharmacy visits per year , while averaging only four visits to their primary care doctor per year. Even more, 80% of treatments today for chronic diseases involve medication therapy .

CarelonRx has long recognized the potential of independent pharmacies. As more stakeholders engage with value-based care, we are innovating new approaches that members, and the healthcare system at large, need.

"Recently, we introduced new types of interactions between members and pharmacists. For example, with our support, pharmacies can test members’ A1C level and engage them to improve their results. Pharmacists that we partner with are also able to perform behavioral health and social drivers of health screenings," explained Stacey Decembrele, Staff Vice President of Pharmacy Network Management and Strategy at CarelonRx.

"These pharmacy-based diagnostic screenings allow more collaborative and informed decision-making between pharmacists and physicians, yielding actionable interventions that are cost-effective and address the whole person."

Independent community pharmacies proved crucial during the COVID-19 pandemic by offering testing, vaccinations, telepharmacy consultations, and home medication delivery. These adaptations during a global health crisis showcased the skills, knowledge, and leadership of community pharmacists and how they meaningfully contribute to health outcomes.

Individuals who were unable to access primary and specialty care due to systemic disruptions and higher demand relied heavily on their community pharmacies to meet their healthcare needs. This reliance isn't likely to change. In fact, the Association of American Medical Colleges projects a shortage of up to 139,000 primary and specialty care physicians by 2033 . This sets up an opportunity for independent community pharmacies to offer more comprehensive medical management at affordable costs — as well as a chance for healthcare organizations to adopt the most effective value-based care models available today.


How can sustainable value-based care in pharmacy work?

As friendly and reliable local institutions, independent community pharmacies are ideally situated to provide personalized disease management and preventive care services. For members with complex treatment plans, having a pharmacist who can take the time to explain medications and potential interactions is instrumental in driving the right outcomes.

Some examples of value-based care provided by independent community pharmacies include:

  • Medication therapy management programs
  • Medication adherence programs
  • Patient education and community engagement
  • Refill reminders
  • Diagnostic testing (e.g., lipid profile, A1C, and blood pressure)
  • Lifestyle and general wellness tips

CarelonRx works with these pharmacies to provide data-based decision support. This enables pharmacists to perform complex medical monitoring for specialty medications, behavioral care, substance use treatment, and other specialized clinical care. By forming partnerships with stakeholders through digital tools, web-based platforms, and data integration, we're enabling complex care for chronic conditions, such as diabetes, kidney disease, and heart disease.

"We're leveraging a clinically integrated network that plays an important role in getting all stakeholders in the care continuum to think about value-based care as a team, with the patient at the center," said Decembrele. "Our goal is to continually innovate our value-based programs so that pharmacies get more comfortable with this model and see that they can perform well using our programs."

One example of CarelonRx's partnership approach can be seen in a program with Amerigroup Iowa and the Community Pharmacy Enhanced Services Network. The program helped identify medically complex Medicaid members with behavioral health needs, such as opioid use disorder, asthma, or chronic obstructive pulmonary disease. Participating community pharmacists provided individualized medication management and tailored health coaching to improve medication adherence and health outcomes.

The capabilities that our pharmacy partners have access to continue to grow, and they will make value-based care only easier to scale. For example, technological decision support and the use of digital tools, such as text messaging and mobile applications, are helping pharmacists further engage with patients in meaningful ways. These tools allow for member interactions that are relatable and actionable, yielding sustained health improvements and greater patient satisfaction at a lower cost.


Independent pharmacies in the future of healthcare


Independent community pharmacies, in the face of growing chronic diseases and provider shortages, are essential in the shift towards value-based care. Their trusted presence in communities make it even more possible to provide personalized, comprehensive care, particularly for underserved populations. Through partnerships, digital tools, and data-driven yet personal interactions, these pharmacies can significantly improve outcomes sustainably.


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