Part one of a two-part series on the success of the Community Pharmacy Enhanced Services Networks, a program that allows a pharmacy of any size to expand its scope of practice and open doors to new revenue streams.
THE CPESN MOVEMENT IS PRIMARILY directed toward small-chain and independent community-based pharmacies. Still, the success of the program is having a ripple effect on many other aspects of the profession. That’s because CPESN networks are successfully expanding the scope of pharmacy practice and at the same time opening up doors to important new revenue streams.
So, no matter your practice setting, here are six things every pharmacist should know about the CPESN program.
CPESN: The First Clinically Integrated Network (CIN) of Pharmacies
ONE: CPESN USA is the first clinically integrated network (CIN) of pharmacies. A CIN is a sophisticated legal arrangement that allows a network’s leaders to sign contracts for services the network provides. The CIN legal structure provides antitrust exemptions, allowing separately owned pharmacies to work together under tightly regulated boundaries.
For the past four years CPESN USA has been working with forward-thinking pharmacy owners all across the country and helping them form local CPESN networks. According to Joe Moose, Pharm.D., owner of Moose Pharmacy in Concord, N.C., and a leader in the movement, a key factor for the success of the movement is local leadership. As of July 1, 2020, CPESN USA says it has 49 local networks and more than 2,500 participating pharmacies.
Another foundational principle of CPESN USA is that of vendor neutrality. This means any pharmacy that qualifies can join without regard to which pharmacy dispensing system, group purchasing organization, wholesaler, or franchise system it uses. While some wholesalers or buying groups have taken a lead in organizing a network, as a condition of their charter they cannot require the pharmacy to become a customer or member of their organization.
The good news, according to Troy Trygstad, Pharm.D., M.B.A., Ph.D., executive director of CPESN USA, is that thousands of pharmacies are already providing the kinds of services required. “Our job,” he says, “is to pull them together into a branded network that can be presented to payers.”
Enhanced Pharmacy Services Actually Lower the Cost of Healthcare
TWO: Moose says that too many pharmacy owners incorrectly think the goal of CPESN networks is to help improve third-party reimbursement. As an owner of several retail pharmacies, he’d love to see PBM (pharmacy benefit manager) reimbursement improve. But he says that thinking CPESN will help with PBM payments would be a mistake.
Instead, he says, the goal of the program is to show payers that the enhanced services pharmacies provide actually lower the cost of healthcare. Much of this is accomplished as the enhanced services that participating pharmacies provide reduce the number of emergency room visits, lessen nursing home admissions, or help patients control their blood pressure and thus prevent strokes — as just some examples. Moose says, “We can definitely make the case to payers that pharmacies should be compensated for these services out of the medical benefit, not the prescription benefit, side of the healthcare budget. That is the central goal of CPESN pharmacies.”
Moose says there are two other critical things for pharmacies to know. First, that every participating pharmacy pays a participation fee to be in the network and enjoy its benefits. The fee supports quality and operations initiatives that make the pharmacy and the network look different, and thus be more attractive to payers. Currently, that fee is $95 per month for every pharmacy location included in the program.
Next, prospective participants should know that CPESN USA is a pharmacy provider-driven organization. That means managers and owners of participating pharmacies recruit new members, and then everyone in the network works to find payers. Participating pharmacies look to CPESN USA for network development tools, payer engagement training, and legal support.
One network leader, Amy Schmidt with North Star Pharmacy and Infusion in Cheyenne, Wyo., says she likes to tell pharmacy owners joining her network to think of CPESN USA as the coach of a sports team. The coach comes up with the plays and trains players on their specific tasks. But when the game starts the coach sits on the sidelines. It is up to the player to block the opponent or to make the catch. She adds, that means being a CPESN pharmacy involves much more than paying the participation fee and reading memos. Schmidt says pharmacy owners need to be actively engaged or the program isn’t likely to succeed.
CPESN Program Is Working
THREE: The program is working, says Chris Antypas, Pharm.D., president of Asti’s South Hills Pharmacy in Pittsburgh, Pa. Antypas is actively engaged in the Pennsylvania Pharmacists Care Network (PPCN), the CPESN network in his state. He says that in 2019 PPCN renewed its enhanced services contract with Gateway Health. The program involves 90 pharmacies that provided services to 2,885 unique patients, and every pharmacy got paid for providing the services.
The Gateway Health contract calls for PPCN members to provide comprehensive medication reviews (CMRs) to patients enrolled in Gateway Health’s managed Medicaid program. While the payment details are confidential, Antypas says the amount is significant enough that nearly all the pharmacies that participated in the 2018 contract agreed to participate in the extension.
CPESN USA reports that networks in Iowa, Missouri, New York, Pennsylvania, South Carolina, and Wyoming, as well as others, have contracts paying pharmacies for services. In their monthly introductory webinar, CPESN USA leaders show a PowerPoint slide of the various types of payer programs. The slide shows that some of the ways that payment comes to pharmacies are as fee-for-service, per-member-per-month, and for meeting performance metrics that improve the HEDIS (Healthcare Effectiveness Data and Information Set) measure.
In addition to being an owner in a progressive pharmacy, Antypas has picked up a second job as the director of pharmacy solutions for Henderson Brothers, an employer benefits broker and consulting firm in Pittsburgh. In talking about his role in helping companies contract for health benefits, he says he has gained a deeper appreciation for the plans, programs, and organizational support CPESN USA provides.
Still, he adds, health insurance is a huge business with lots of moving parts. Antypas says, “Winning the battle against the big PBMs will require thousands of pharmacy owners working together. I see no better way to accomplish this than through the CPESN movement.”
CPESN USA has come a long way since its founding in 2016. Forty-nine CPESN networks have more than 2,500 participating pharmacies. Over 20 of those networks have active payer contracts paying their pharmacies for providing enhanced care services.
In the next issue of ComputerTalk you will learn about three more aspects of the program, including the launch of EngageRx. This is the marketing program that pulls it all together and, according to Troy Trygstad, will take the program to the next level. CT
Bruce Kneeland is an industry expert who focuses on helping pharmacists find new and better ways to serve patients. He can be reached at BFKneeland@gmail.com