28 Operations & Management
Pharmacy Practice News • January 2022
Managed Care
Population Health Drives Cost Savings in Diabetes By Jillian Mock
Denver—In North Carolina, a local hospital system partnered with a health insurer to implement a population health program to reduce costs and increase care quality for patients with diabetes. The program illustrates how pharmacists can use detailed data to bolster value-based care efforts, according to the case study presented at AMCP Nexus 2021.
“The key to our population health team is robust data,” said co-investigator Molly Hinely, PharmD, BCPS, the pharmacy clinical coordinator for population health at Atrium Health Wake Forest Baptist. “Where do we get that data? We get it from the health payor.” In the United States, spending on diabetes care doubled in a 10-year period, from $116 billion in 2007 to $237 billion in 2017, according to the American
Diabetes Association (ADA) (Diabetes Care 2020;43[10]:2396-2402). The costs of institutional care decreased from 2012 to 2017, but spending on outpatient services, medications and supplies increased (Diabetes Care 2018;41[5]:929-932). In North Carolina, about 11.3% of the adult population was diagnosed with diabetes in 2019, according to the ADA (bit.ly/3Dxu3WK), compared with
10.8% in the country as a whole, according to the CDC (bit.ly/3pTqy8j). On the payor side, Blue Cross Blue Shield of North Carolina (BCBSNC) has an advanced payment model program (called Blue Premier) that links costs and fees to quality and value of care. As part of that program, the researchers looked at data collected on prescribed medications, fill history and care gaps. “The data we collect support our mis-
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sion of making prescription drugs more affordable and improving outcomes for members,” co-investigator Brenden O’Hara, RPh, BCACP, a clinical pharmacist at BCBSNC, said in an email interview. Improving collaboration between payor and provider groups is a huge focus for the program, he noted. In 2021, Mr. O’Hara and his team focused on providing data to healthsystem pharmacists that could translate into immediate savings. This included identifying opportunities for providers to move patients to more affordable, clinically equivalent alternative medications, prescribing more affordable and effective combination therapies, and implementing real-time benefit checks, Mr. O’Hara said. “I am witness to the fact that the information they’re able to provide for the health systems is extremely helpful to us,” Dr. Hinely said during the meeting presentation. Dr. Hinely’s population health team is heavily focused on value-based pharmacy services, she noted, working in various care settings including rural health in Catawba County and the WinstonSalem urban center. Atrium Health has five campuses, one academic medical facility, four community hospitals, and nine community and specialty pharmacies, she said. Although Dr. Hinely’s team works with Medicare and Medicaid health plans and contracts, the department’s largest contract is commercial
