Key Insights

• “When they hired me on, they knew that they needed help with addressing our medication-related quality measures. They also knew they needed help with spend … high-cost drug utilization, both on the Part B and the Part D side. And then there was the general bucket of: We know patients are experiencing medication-related problems that are probably putting them at higher risk of hospitalization or ED utilization. – Brittany Orr, PharmD, BCACP, Vice President, Quality, Millennium Physician Group
• “As a pharmacist, I think we could always plug the pharmacy in as part of the solution. So I think it was really a game of assessing and making sure that we were being strategic and which services that we plugged in to drive that value-based performance, improve patient outcomes, improve patient safety, and overall, those things are going to have a drive line to value.” – Orr
• “I think in the early days of pharmacy, it was very much focused around the quality Stars measure side of things. As we mature our thinking around pharmacy, it’s really been that shift in mindset of how do we use pharmacy as opposed to more of a managing pharmacy spend to actually strategically increase pharmacy spend in certain areas to reduce admission and total cost of care in the long run. – Calvin Richardson, Senior Director, Clinical Strategy, agilon health

Key Insights

• “Looking at each measure, not by how does CMS categorize this measure as being a pharmacy measure, but really what interventions can we put in place to support overall measure performance. And so current state as a comprehensive group of clinical pharmacy services between Stellus as our extender and our in-house team, we’re now touching medication adherence, statin therapy measures, med rec post-discharge, uncontrolled diabetes, short of taking diabetic eye exams, right? It’s been pretty neat to see all of the different ways that we can support from a quality perspective.” — Orr
• “I think our experience with the adherence work has shown both the importance and the relative ease of expanding the care team to add pharmacists to the work that we do on a day-to-day basis. I think our partnership with Stellus Rx has been a big lever in that … to have pharmacists that we can have interacting within our EMR, running similar protocols across our entire footprint, and really feeling like it’s part of the care team for the PCPs builds confidence that not only can we perform better on our Star scores, but also with other ideas out there could we lever pharmacy against to improve care for patients. – Richardson
• “If we had said out of the gate, you’re going to have a pharmacist now doing this clinical pathway work, you probably would have had a different reaction from PCPs. So it’s more of a natural outgrowth as opposed to an independent idea.” – Richardson

Key Insights

• “We take care of over 150,000 Medicare Advantage patients. So if that was still being managed by my team, we wouldn’t have the ability to be as proactive and responsive to some of the other value-based care initiatives that are going on within the organization. – Orr
• “When we knew the polypharmacy measures were coming, it allowed us an opportunity to sit down, work directly with the payers. And in some cases, we were even ahead of the payers from a resource and data and targeting perspective. We were able to hammer out our plan of what our interventions and what our education plan was going to look like internally. And I think the ability to just be proactive and responsive in advance of two new brand new measures that are inverse measures and honestly, kind of hard measures to meet and work with our primary care physicians to drive performance.” – Orr
• “With that suite of wraparound services, we do see that it’s also a blended outcome, a blended impact. So instead of saying, you know, the pharmacy intervention drove the Star score from this to this, now we are one of many interventions that potentially decrease the admissions per thousand or decrease total cost of care.” – Orr

Key Insights

• “I think the teams that use pharmacy well think about it in that more rigorous way. Who are the patients who have a known gap here that I can get closed. Either they’re on too many meds or they’re not on the right ones given their clinical conditions or they’re not on them consistently enough to drive down ADK in the future. So what is kind of the discrete problem we’re looking at? Do we have a program in place that we can refer to quickly? How long are they in? When do we graduate them?” – Richardson

Key Insights

• “I like to view it as we’re a comprehensive suite of services, right? So when I go and I give a talk to our physicians, I talk about all of the clinical pharmacy support that they have. We have clinical pharmacists and pharmacy technicians and that we’re extended by our partnership with Stellus Rx. And so I deliberately generalize it. So that to them, it makes no difference. In the chart, when they see the intervention from the Stellus pharmacist versus the Millennium pharmacist, it really doesn’t matter. They’re really baked in to our level of access, to the communication with the team in terms of the clinical intervention. And then we can just continue to show that same face and just advertise as more of that comprehensive suite of services. – Orr
• “There’s been many instances, for example, where Millennium internal team managed adherence for North Carolina for an extra six months. And then once we got the care teams and the physicians used to the process, we plugged Stellus Rx to go ahead and take that service line over. And so I personally think it’s happened really naturally and just really appreciate the partnership.” – Orr

Key Insights

• “We also have some drug utilization review activities that our pharmacy team participates in. And we were able to expand upon those and expand across all four markets. So we’ve really been able to grow with the organization.” – Orr
• “We’re piloting an extensivist program in one of our regions. Every single patient enrolled in this extensivist program has a full pharmacy referral in advance of their first appointment with the extensivist, which is pretty incredible. And it’s just one example of many of where we’ve really been able to just meet the organization where we’re at and where we’re going and know that adherence is taken care of, statin therapy is taken care of, and that if we need to continue to ebb and flow, who does what behind the scenes, as long as we’re delivering a comprehensive clinical pharmacy service to our patients and our physicians, then I think that’s really the recipe to success.” – Orr

Key Insights

• “It’s making it feel like it’s one team. And if that’s your goal, one team for both patient and for PCP, technologically, like pharmacists needs to be in the EMR, seeing patient data, messaging, having all that same interaction as if they were down the hallway.” – Richardson
• “As part of our value-based care approach, we’re having PCPs review their panels on a consistent basis to look for patients proactively who may need additional support, in case you’re not thinking of it in the exam room next time they’re in, having that kind of set time to review, take notes, take action items out of that and using that to tee up pharmacy support.” – Richardson

Key Insights

• “You have to follow the data, right? You have to follow what your insights are telling you to drive your overall outcome. We have to make sure we’re following the data and the insights that we’re getting on our population and doing what’s right for the patient, which is ultimately what’s going to help us perform better in value-based care.” – Orr
• “Where I see the world going and the industry, and our organization, is how do I leverage pharmacy to drive better care for patients that result in lower cost, more days at home, lower out-of-pocket costs for patients, better quality of life for them. I have this capability, how do I use it in a broader sense, in a way that I want to, as opposed to, I’m told that I must do this thing.” – Richardson