Quality improvement is at the top of healthcare stakeholder’s to-do list, but in 2024, payers and pharmacies will need to collaborate more effectively to elevate member experience – and keep Americans safe and healthy.
Payers always have big holiday wish lists heading into the first quarter of every New Year, and 2024 is no different — especially when it comes to their relationship with their chain and community pharmacy partners.
The last 12 months brought many impactful changes to the forefront, between regulations prioritizing health equity to prescription drug pricing reform to the rollout of new programs to keep the cost of medications low – and keep members happy.
So what’s next? Here are three clinical areas that payers and their pharmacy care partners will need to emphasize in 2024:
Member engagement tactics
Besides the desire for lower drug prices, the biggest collective wish among health plan members is for care that feels personalized. And since Americans already visit their community pharmacy twice as often as their primary care provider, now is the time to leverage that member-pharmacist relationship to elevate high-touch care delivery.
In 2024, small efforts could yield big results. Consider one recent study, involving pharmacists who simply called patients to talk to them about their medication, address barriers, and facilitate refills. Those conversations paid off, and overall adherence rates for diabetes, hypertension, and cholesterol medications went up. All due to a simple activation from the patients’ local pharmacist.
Payers and pharmacies can level up communications by tailoring outreach (such as reminders) to patient preferences (which are increasingly digital). For instance, when using the Outcomes platform, pharmacies report that 32% of medication-related problems are resolved quickly, while 79% of refill requests are picked up by patients.
Health Equity and Accessibility
CMS’ 2024 Medicare Advantage and Part D Final Rule ushered in significant changes, including the establishment of a health equity index (HEI) reward in the Star Ratings program beginning with the 2027 Star Ratings.
Given that social determinants of health (SDOH) significantly influence medication adherence, finding ways to improve accessibility and engagement for patients with one or more social determinants will be a key to success in 2024.
Payers that leverage a strong network of pharmacies will gain strategic insights that can help them address root causes of non-adherence. In turn, payers can also take advantage of pharmacy and other partner programs, like Outcomes’ collaborative partnership with CaringWire, a digital navigation and coordination platform that helps customers connect to healthcare resources.
Chronic Care Management
Chronic conditions such as diabetes, hypertension, and obesity are a big driver of $4.1 trillion in annual U.S. healthcare costs, many of which stem from hospital admissions. Yet while the rise of chronic conditions can’t be controlled, there is a lot that payers can do to reduce emergent care.
For example, working directly with pharmacies to improve medication adherence: Interactive, personal interventions have helped keep chronically ill members out on top of their medications and out of the emergency room. Plans average 7% lower rates of hospitalization and ER visits when their pharmacy partners use Outcomes.
While 2024 will bring a lot of challenges to payers and their pharmacy partners, focusing more resources on these three areas will help plan members stay healthy – while lowering costs and improving quality metrics.
