For people with complex health and social needs who also have complicated drug regimens, pharmacists can provide patient-centered, enhanced medication management services in coordination with other providers aimed at reducing risks and improving outcomes. However, due to many pharmacy and drug services being carved out from other medical services within health plans, it can be challenging to arrange Medicaid reimbursement for community-based pharmacy services, such as comprehensive medication review, mediation home delivery, and tailored packaging.

In an effort to address this issue, pharmacists and health care organizations across the country are experimenting with value-based payment approaches. During this 90-minute webinar, participants from two sites participating in the Community Management of Medication Complexity Innovation Lab, a national initiative led by the Center for Health Care Strategies with support from the Gordon and Betty Moore Foundation, will describe their innovative reimbursement models and tips for building the business case for payers to cover enhanced medication management services.


I. Welcome and Overview of the Community Management of Medication Complexity Innovation Lab

Speaker: Caitlin Thomas-Henkel, Senior Program Officer, CHCS

C. Thomas-Henkel will welcome participants and introduce the panelists, Amanda Brummel and Randy McDonough. She will provide a brief overview about how providers and health systems are addressing medication complexity through community-based medication management strategies.

II. Making the Business Case for Enhanced Medication Management Strategies

Speaker: Randy McDonough, PharmD, Co-owner of Towncrest Pharmacy

R. McDonough will discuss a pilot in which Towncrest Pharmacy worked with a major payer in Iowa to stratify patients based on their clinical risks and provide continuous medication monitoring (CMM). He will describe the process for developing a business case for payers, including gathering data, calculating a return on investment, and “pitching” a pilot to key stakeholders. R. McDonough will also share interim outcome measure and total cost of care results, along with lessons learned.

III. Comprehensive Medication Management Services at Fairview: Creating the Business Case

Speaker: Amanda Brummel, PharmD, Director of Clinical Ambulatory Pharmacy Services, Fairview Health System

A. Brummel will describe clinical development and integration of ambulatory pharmacy services at Fairview Health System, a large health system and health plan in Minnesota, including approaches such as comprehensive medication management, transitions of care, and quality outcome measurement. She will also discuss value-based payment models that Fairview is using to reimburse for comprehensive medication management within Minnesota’s Integrated Health Partnerships, the state’s Medicaid ACO program that launched in 2013; Medicare Advantage partnerships; and commercial products that are in partnership with various health plans.

 IV. Moderated Q&A

Moderator: Caitlin Thomas-Henkel

Additional Resources

Pharmacy Performance While Providing Continuous Medication Monitoring – This article, from the Journal of the American Pharmacists Association, describes the reimbursed continuous medication monitoring program between a commercial payer and Towncrest, a community pharmacy, and the effects on total cost of care, medication adherence, and use of high-risk medications.

The Patient Care Process for Delivering Comprehensive Medication Management: Optimizing Medication use in Patient-Centered, Team-Based Care Settings – This report discusses the importance of clearly defining and consistently implementing CMM, a practice used by Fairview Health System, across care settings so that it can be supported by a business case for scaling and sustaining the service and ultimately improving patient care.