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Independent, But Not Alone:CPESN

Community Pharmacy Enhanced Services Networks

In an industry riddled with acronyms, one is emerging as the future of community-based pharmacy: CPESN. What began as a three-year grant has now become a nationwide movement for pharmacy’s role in healthcare reform.

The idea of community pharmacy enhanced services networks was conceived in early 2013 by a group of primary care providers in North Carolina who had a vision of collaborating closely with community pharmacies to help manage complex patients. Not long after a CPESN network was formed in North Carolina, the Center for Medicare & Medicaid Innovation (the CMS Innovation Center) recognized the promise of these open networks that were focused on improving the outcomes of high-risk patients who tend to visit their pharmacies more than their physicians and awarded them with a demonstration project to figure out how to integrate pharmacies with the rest of the care team. These networks seek to unite all members of the patient’s healthcare management team to optimize the use of medications and lower overall healthcare costs. Additionally, they give pharmacists the tools to coordinate medicine-centric care for patients by promoting services such as compliance packaging, hand delivery, and synchronization.

Director of Strategy and Luminary Development Joe Moose recalls his beginnings with CPESN as being chased by a group of psychiatrists. After explaining Moose Pharmacy’s adherence program to a room of 350 psychiatrists, Moose left the panel with no inclination he had piqued the curiosity of some of the attendees. As he walked down a hallway, he turned around to see a group of psychiatrists running after him and calling out to him. “They all wanted to know where the other pharmacies that were offering services like adherence were located,” he explains. “That’s when I realized this isn’t a Moose Pharmacy thing — it’s an all-pharmacy thing that includes pharmacists who are working at the top of their licenses and the top of their ability.”

Troy Trygstad, executive director of CPESN USA, LLC, had a similar moment of realization (without being chased by psychiatrists). “I’m still an employee of CCNC (Community Care of North Carolina), and I’m a part of this larger medical neighborhood structure where we’re having a lot of conversations about what the next-generation Medicaid program will look like,” Trygstad explains. “It was amazing to me, the level of receptivity outside the pharmacy world. All of these players working outside of the pharmacy bubble, as a whole, were very receptive to this idea of paying pharmacies to provide care management-like services.” Troy initially approached the CCNC care managers and physician leaders three years ago and asked if they were already participating in an “unconventional” model of healthcare that involved co-managing patients with pharmacies. “When I asked them, I figured we’d receive three or four pharmacy names that are doing this,” Troy recounts. “In five business days, we received 147 pharmacy names. Out of those 147 pharmacies, more than 90% of them were independents because they already had these established, local relationships with these practices and had built out these services lines out of a necessity to differentiate themselves.”

If nonpharmacy members of the healthcare system are proving to be open to the idea of interrelated care networks, it certainly begs the question — why hasn’t it always been this way?

Healthcare actually used to be an open network of communication across all members. The conception of pharmacy benefit forced a divide between pharmacy and the rest of the healthcare management team, and since the 1980s, pharmacy has dealt with the negative effects of pharmacy benefit managers. These include DIR fees, formularies, delayed reimbursements, and many more problems pharmacists currently struggle with. When pharmacists can connect with prescribers and care managers, their patients have a higher chance of staying out of the emergency room.

Through CPESN, independent pharmacists can finally prove their value and be compensated for it.

“Our goal is not to do the fishing for them. Our goal is to have a learning collaborative of fishermen who realize they’re in an ideal position to change how patient care is done. Now, we’re helping these fishermen and fisherwomen to have the confidence and the marketing and quality assurance tools to go catch fish.”

— Troy Trygstad

Although CPESN originated in North Carolina, Moose and Trygstad are working to make these networks a national standard of care, one Troy describes as a “network of networks.” CPESN has a list of national standards all states should follow, such as medication synchronization, and each state network can establish its own additional local standards. “It’s not about us. It’s about how we are helping these local networks be strong in a decentralized model,” says Trygstad. “How we’re different is we don’t take the approach of gathering as many pharmacies as possible to have a network to contract. That’s not the idea at all. What we’re trying to do is find that subset of pharmacies that can really knock it out of the park for these other partners within healthcare.” Individually, pharmacists will struggle to express their value. In a local network, they can band together to leverage their potential and access the Clinical Integration they need to work directly with payers.

Technology plays a critical role in CPESN’s mission to unite all members of healthcare. There was a pushback in the beginning because pharmacists had to log in outside their workflow, which was inconvenient and time-consuming. Currently, there are 23 technology vendors working with CPESN to implement new standards and practices with the systems pharmacists are already using. Moose, who reached out to his own local “network” of colleagues when he was looking for a new pharmacy management system, understands the vital role technology plays. “We think that the technology leaders, just like the pharmacy leaders, will rise to the top in this venture,” he says. “We’re relying on pharmacy management systems and add-on systems to help us with this new workflow model that’s developing.” Pharmacy technology helps CPESN with initiatives like electronic care plans that prove pharmacists are improving patient care and delivering outcomes, along with creating a meaningful method of communication between prescribers and pharmacists. “As vendors start to adopt these care plan capabilities, the pharmacies gain the ability to choose the systems that work with them and their workflow to deliver clinical services and communicate with other medical team members,” Trygstad explains.

As Moose, Trygstad, and their team have worked directly with pharmacists to establish local networks, their vision for the future is for pharmacists to be more involved in the process, or in Trygstad’s words, “fish” for local payers and pharmacists who want to be involved in a network.

By empowering pharmacists who want to elevate their care and build relationships with providers, CPESN is knocking down the wall that divides all members of healthcare. When pharmacists have the means to communicate and strategize with each other and local prescribers, everyone can work together to innovate the future of patient care.

If you’re interested in joining CPESN, go to and look for your state on the map. Reach out to the local luminaries in your state, or email to be connected with a local network.

Caitlin Sattler
PioneerRx | Journalist
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