In this episode of The Dish on Health IT, Tony Schueth, CEO of Point-of-Care Partners (POCP), welcomes Angel Ballew, Head of Pharmacy Clinical Programs & Services at Centene Corporation, along with Seth Joseph, Managing Director of Summit Health Advisors, and Jason Reed, Senior Consultant at Point-of-Care Partners, for a discussion about what it will take to scale pharmacist-delivered clinical services.
In this episode of The Dish on Health IT, Tony Schueth, CEO of Point-of-Care Partners (POCP), welcomes Angel Ballew, Head of Pharmacy Clinical Programs & Services at Centene Corporation, along with Seth Joseph, Managing Director of Summit Health Advisors, and Jason Reed, Senior Consultant at Point-of-Care Partners, for a discussion about what it will take to scale pharmacist-delivered clinical services.
The conversation builds on findings from the NCPDP Foundation-funded white paper, A Business Model Framework to Scale Pharmacy-Delivered Clinical Services, developed with contributions from Point-of-Care Partners and Summit Health Advisors. The research starts from an important premise: there is already significant evidence that pharmacist-delivered clinical services can improve patient outcomes. The harder question is how to make those services operationally and financially sustainable at scale.
Tony begins by asking Angel about the role pharmacists can play in closing care gaps, particularly for vulnerable and rural populations. Angel notes that Centene serves approximately 3.5 million people living in rural communities, but emphasizes that access challenges extend beyond geography to transportation, housing, food insecurity, and other social determinants of health.
Against that backdrop, pharmacists can be among the most accessible healthcare professionals in a community and may interact with patients more frequently than physicians or other providers. Angel describes opportunities for pharmacists to reinforce medication adherence, identify medication-related concerns, provide immunizations, support test-and-treat services, conduct screenings, and perform other clinical services. As states continue expanding pharmacists’ scope of practice and provider recognition, she sees opportunities to further integrate pharmacists into the healthcare team, particularly in communities with limited provider access.
Seth and Jason broaden the discussion by sharing what emerged from the stakeholder interviews and industry research behind the white paper. Pharmacist-delivered services are already being piloted or implemented across areas including gaps-in-care counseling, test-and-treat programs, medication counseling and medication therapy management, immunizations and preventive screenings, and chronic disease management. Jason notes that pharmacists can play an important role between physician visits for patients managing conditions such as diabetes and hypertension.
The conversation then turns to one of the biggest obstacles to scale: reimbursement and credentialing. Angel describes the tension between generating enough patient volume to make participation worthwhile for pharmacies and demonstrating enough outcomes and value to justify health plan investment. She discusses Centene’s work to make credentialing requirements clearer for pharmacy partners, including the internal education required to bring pharmacy into processes traditionally designed around other healthcare providers.
Tony asks Seth what the research suggests needs to change. Seth explains that the findings pointed strongly toward health plans and pharmacies working together to lead the development of sustainable models. Pharmacy benefit managers remain important participants with established relationships, networks, technology, and processes, but Seth describes the difficulty an innovative program champion within a PBM can face when they must first secure a client and then assemble participating pharmacies. Health plans may have greater ability to initiate programs and bring the necessary parties together, although their different lines of business and geographic markets add their own complexity.
Angel shares how some of this has played out at Centene. The organization has worked directly with pharmacy communities and industry partners, often state by state because of differences in pharmacist scope-of-practice requirements. At the same time, Centene has developed a national program with consistent quality measures and an infrastructure that can support additional pharmacy service opportunities.
That experience provides a real-world look at what scaling can require. Angel describes participation approaching 73 percent nationally and nearly 30,000 pharmacies contracted to participate in the program, including growth of more than 10,000 pharmacies over the past several years. She points to consistency as an important part of building participation. Rather than continually replacing programs with something new, Centene has gathered feedback and iterated, helping pharmacy partners gain confidence that the opportunity is stable enough to warrant their investment.
The discussion then returns to a central finding of the white paper: the “cold start,” or chicken-and-egg, problem. Pharmacies may hesitate to invest in technology, staffing, workflow redesign, and clinical capabilities until sufficient patient volume exists, while health plans want sufficient pharmacy participation before investing in programs and measuring outcomes. Meanwhile, differences in credentialing, enrollment, reimbursement, contracting, and reporting continue to create practical barriers.
Tony introduces the concept of regional Pharmacy Health Alliances for Reimbursable Medical Services, or PHARMS, as one potential approach to addressing the cold-start problem by bringing health plans and pharmacies together within a geographic market.
Angel agrees that the concept begins with the right problem. The industry does not lack evidence that pharmacists can improve outcomes or help address gaps created by provider shortages. What remains less aligned is the business model. She cautions, however, that health plan operations vary considerably across lines of business, patient populations, benefit designs, quality priorities, and state Medicaid requirements. A regional model therefore needs enough flexibility to account for those differences.
Seth explains that this variation is precisely why the research pointed toward regional collaboration rather than attempting to solve every issue nationally at once. The goal is not necessarily complete standardization, but identifying enough commonality among health plans and lines of business to prioritize a smaller number of services and begin building the infrastructure needed to support them.
Angel views those complexities as design considerations rather than reasons not to pursue regional collaboration. She also sees the potential for lessons and common approaches developed regionally to eventually contribute to greater standardization nationally, particularly within individual product lines.
Jason brings the discussion back to the pharmacy perspective. Pharmacies need confidence that services will be reimbursed before they can reasonably invest in technology, redesign workflows, train staff, and begin documenting clinical care differently. Regional collaboration among multiple payers could give pharmacies greater confidence that those investments will support sufficient patient volume while creating value for patients, pharmacies, and payers.
From there, the conversation moves to another critical requirement for advanced pharmacy practice: data interoperability. Tony points out that pharmacists cannot effectively close care gaps if relevant clinical information remains siloed.
Angel agrees that pharmacists need timely, actionable clinical information and enough context beyond the dispensing system to intervene effectively. At the same time, she cautions against overwhelming pharmacists with more information than they can realistically use within their workflows. She also challenges the idea that interoperability must be an all-or-nothing proposition. While the industry continues working toward a more ideal interoperability environment, imperfect data exchange should not prevent health plans and pharmacies from making progress today.
Jason expands on the interoperability challenge by discussing the emerging concept of a pharmacy EHR. Pharmacy management systems are highly effective at supporting medication dispensing and claims transactions, but advanced clinical services require additional information. He argues that the answer is not simply to deliver the entire EHR to the pharmacist. Instead, the industry needs to identify the minimum actionable clinical information pharmacists need to make better decisions and perform specific services.
Just as importantly, Jason emphasizes that pharmacy interoperability must be bidirectional. Pharmacists increasingly generate clinically valuable information through patient interactions, and that information also needs to reach providers and other members of the care team. Angel notes that Centene already receives some information back from pharmacies, including through programs involving social determinants of health, although the more seamless bidirectional infrastructure envisioned by the group is still developing.
Looking ahead five years, Seth describes himself as a “data-driven optimist.” He points to momentum across private-sector organizations, national and independent pharmacies, state governments, and policy initiatives. While significant reimbursement, policy, and infrastructure challenges remain, he believes many of the pieces needed to overcome the cold-start problem are beginning to come together.
Angel shares that optimism. Her hope is that pharmacists become a much more integrated and visible part of frontline healthcare delivery. The COVID-19 pandemic demonstrated how accessible and valuable pharmacists can be when the healthcare system needs them, and she sees an opportunity to continue moving the profession beyond its traditional dispensing role.
Jason adds that demographic pressures, including an aging population and primary care capacity challenges, will continue creating demand for pharmacists to practice at the top of their licenses. He expects states to continue expanding pharmacist prescribing authority and clinical roles while technology, interoperability, and potentially AI help pharmacies operate more efficiently and support broader clinical services.
Tony closes with the question asked of every guest on The Dish on Health IT: what is one habit or perception healthcare stakeholders should change or revisit starting tomorrow?
Angel challenges listeners to think about pharmacists as more than medication experts. They are also access experts. In a healthcare system facing provider shortages, increasing complexity, barriers to care, and pressure to improve quality, she encourages healthcare leaders to ask how they can better leverage one of the most accessible healthcare professionals available in nearly every community.
Rather than focusing only on what pharmacists dispense, Angel leaves listeners with a broader question: What can pharmacists prevent or help solve?
The episode closes, as always, with the reminder that Health IT is a dish best served hot.
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