EmblemHealth, PQS bring enhanced care to members with diabetes
EmblemHealth, one of the nation’s largest nonprofit health insurers, is partnering with Pharmacy Quality Solutions, a provider of performance management services, to support member health and close gaps in care through a first-of-its-kind pharmacy value-based arrangement in New York.
The arrangement began in July 2023 and became fully operational at the start of August 2023.
Eligible EmblemHealth members with diabetes and/or hypertension can now receive blood pressure and A1C screenings at 4,000+ participating network pharmacies, including national and regional chains, and many independent pharmacies throughout New York. The innovative partnership incentivizes network pharmacies to capture and share these screening results with EmblemHealth via the EQUIPP platform.
Pharmacies can view patient opportunities in the EQUIPP enhanced services dashboard to perform patient outreach and document needed screening information. With PQS’ expertise in quality improvement, pharmacy data is mapped to National Committee for Quality Assurance quality measures and returned to payers for data ingestion and care coordination.
EmblemHealth’s care management team will share the results with the member’s primary care provider and reach out to the member about their results all with the overarching goal of encouraging healthier living. Members may also be referred to their attributed PCP or the EmblemHealth family of companies’ primary and specialty care practice AdvantageCare Physicians for comprehensive health care services.
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Focused on improving health outcomes in New York, the new partnership complements an existing medication adherence management program that began in March 2023. Both programs recognize pharmacies that achieve higher quality scores, improve health outcomes and serve as trusted community destinations for care.
“As the only New York-based health plan offering this additional service to members, EmblemHealth is proud to lead the way in value-based care management for individuals living with diabetes,” said Abdou Bah, EmblemHealth’s senior vice president of medical management and chief health equity officer. “Our partnership with Pharmacy Quality Solutions enables us to strengthen relationships with the city’s pharmacies—the cornerstones of community care—while continuing to redefine the scope and reach of healthcare access for members at every touchpoint.”
PQS vice president of client services Emily Endres added, “PQS is focused on improving patient health through quality measurement and payer-pharmacy collaborations. Our new enhanced services capability in EQUIPP enables our partners with a pathway to value-based care. We are proud to partner with EmblemHealth to empower pharmacies to provide needed screenings, like blood pressure and A1C, to help their members improve health outcomes.”
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The value-based arrangement is one of the many ways EmblemHealth continues to educate members, patients and New Yorkers on managing chronic conditions. Last spring, the health insurer partnered with healthcare stakeholders for an informational webinar titled Diabetes and Kidney Disease: How to Manage, Cope, and Advocate for Yourself, a follow-up to 2022’s first Diabetes Prevention Webinar discussing risk factors, prevention measures and treatment options to encourage healthier decision making for members living with chronic conditions.