Program featuring Prime pharmacists takes the gold at AMCP

Prime’s GuidedHealth® Care – Smart Adherence program analyzes a health plan’s population and produces a list of members ranked by risk of nonadherence. (The program focuses on Medicare’s Star Rating categories of diabetes, high blood pressure and high cholesterol.)

Prime’s team of pharmacists starts at the top of the list and makes outreach calls. Each call targets that member’s situation, helping to anticipate and overcome any future barriers to adherence issues.

Wait. What? Before the members are nonadherent?

How do we know? Prime studied hundreds of member characteristics and millions of pharmacy claims to determine correlations with nonadherence. We put that together with predictive modeling to give us a look at risk factors. The resulting product was Smart Adherence.

“The predictive modeling gave us the right list of people to call.” said Stephanie Dauer, senior director, clinical program development. “The pharmacist outreach calls brought it home,” added Stephanie.

The pharmacist call educated members on the importance of taking their medication as prescribed and provided resources to help overcome barriers that may contribute to stopping their medication.

It’s shown to work

Prime’s health outcomes team submitted a study on the program to the Academy of Managed Care Pharmacy (AMCP). The research received a gold award and will be presented at AMCP Nexus Oct. 29-Nov. 1 in National Harbor, Md.

And that’s good

The increased use resulted in estimated Star Rating increases of 1.07 percentage points, on average, among the three disease states. A single percentage point increase can make the difference between a 3 to 4 or 4 to 5 Star Rating.

Thanks to all Prime’s pharmacists during October – American Pharmacists’ Month.

Prime has hundreds of pharmacists in a wide variety of careers across many parts of our business, all looking to make health care work better for people.