Implementing payer partnerships for patient care programs within clinically integrated networks of community...

Community pharmacy partnerships expanding patient care opportunities are growing through clinical integration. Practice transformation efforts through the Community Pharmacy Enhanced Services Networks (CPESN USA) have supported over 100 state and national payer programs. While previous work identified themes for sustained program success, program facilitators indicated a need for additional insight into program design, execution, and evaluation.

To identify successful practices for implementing patient care programs in collaboration with health payers across community pharmacy networks nationwide.

This qualitative study consisted of an online demographic survey and semistructured interviews conducted in 2023 with CPESN USA program facilitators. The Practical, Robust, Implementation, and Sustainability Model framework was used for developing study materials. Descriptive statistics were utilized to analyze the survey. A rapid analysis approach was used to evaluate and summarize major themes from the interviews.

Of 43 eligible program facilitators across 40 networks, 14 completed the survey and interview. Participants varied in years of experience, with 6 (43%) having 1-3 years and 8 (57%) having 4-6 years. Pharmacy networks averaged 119 pharmacies and a cumulative average of 7 payer programs. Twenty-three total themes for developing and implementing patient care programs within community pharmacies were categorized in the following sections: 1) engagement, 2) program intervention and design, 3) contract set-up, 4) communication across program collaborators, 5) training (preparing for service implementation), 6) outcomes assessment, 7) data collection, and 8) payment mechanisms.

Keys to successful community pharmacy-payer programs include collaborative program design, ongoing dialog, effective evaluations, technology utilization, and evolving payment models. Findings can be utilized to implement successful partnerships with payers, supporting the integration of community pharmacies into value-based care models.