AmeriHealth Caritas Pennsylvania Launches Initiative to Help Medicaid Members with Hypertension and Diabetes
Health plan enlists local pharmacists to help improve member engagement to improve health outcomes
January 22, 2024 - Harrisburg, Pa.
AmeriHealth Caritas Pennsylvania, a Medical Assistance (Medicaid) managed care plan serving central, northeastern, northwestern and southwestern Pennsylvania, and part of the AmeriHealth Caritas Family of Companies, has launched a new initiative to help Medicaid members diagnosed with hypertension and diabetes better manage these chronic conditions.
The managed care organization is working with the Pennsylvania Pharmacists Care Network (PPCN), an organization of 180, mostly independently owned, community pharmacies in the state, to enhance member engagement and health services to help improve patient health outcomes. PPCN will work with AmeriHealth Caritas Pennsylvania (ACPA) to identify members with gaps in care based on their prescription fill history at a PPCN pharmacy. There are approximately 11,317 ACPA members who would qualify for this program.
Marge Angello, market president for AmeriHealth Caritas Pennsylvania, said member engagement is essential in improving health outcomes.
“It is not uncommon for our members to have more contact with their local pharmacist than their primary care physician,” said Angello, who is also a registered nurse. “A program that encourages pharmacists to help identify gaps in care while making sure medications are used appropriately is a unique approach to expanding access to quality health care.”
When ACPA members pick up their medications at the pharmacy for either diabetes or hypertension, PPCN pharmacists provide a comprehensive medication review along with identifying non-clinical factors impacting their health and wellbeing, such as social determinants of health (SDOH). Pharmacists work with the member’s primary care physician (PCP) to issue blood pressure monitors to members who will be instructed to record and share their blood pressure readings with their PCP.
Monitoring blood pressure and glucose levels is critical for the detection and management of hypertension (high blood pressure) and diabetes (high blood sugar), respectively. According to the Centers for Disease Control and Prevention (CDC), among the 108 million people in the U.S. with hypertension, just 1 in 4 have their conditions under control. This elevates their risk for heart attacks and strokes.
According to a recent study on the prevalence of uncontrolled hypertension among low-income patients, those with diabetes had substantially less control of their blood pressure than the general population. This fact underscores the urgent need for new strategies to improve blood pressure control to help patients manage these chronic conditions.[i]
While the first phase of this program will support members with hypertension and diabetes, it will soon expand to include those with other chronic conditions such as asthma, COPD, substance use disorder and behavioral health conditions, said Stephanie McGrath, PharmD, PPCN’s executive director of network operations.
“Community pharmacists play an important role in caring for the medication-related needs of their patients, especially those with chronic health conditions,” she said. “PPCN pharmacists engage in their patients' health care, offering high quality patient-centered care — helping payers, providers, and patients all reach the outcomes they need and deserve.”
About AmeriHealth Caritas Pennsylvania
AmeriHealth Caritas Pennsylvania is a Medical Assistance (Medicaid) managed care health plan serving 62 counties in central, northeastern, northwestern, and southwestern Pennsylvania. Headquartered in Harrisburg, Pennsylvania, AmeriHealth Caritas Pennsylvania is a mission-driven company dedicated to helping members get care, stay well, and build healthy communities. For more information, visit www.amerihealthcaritaspa.com.
About AmeriHealth Caritas
AmeriHealth Caritas is one of the nation’s leaders in health care solutions for those most in need. Operating in 13 states and the District of Columbia, AmeriHealth Caritas serves approximately 5 million Medicaid, Medicare, Children’s Health Insurance Program (CHIP), and Health Insurance Marketplace® members through its integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, and behavioral health services. Headquartered in Newtown Square, Pa., AmeriHealth Caritas is a mission-driven organization with more than 40 years of experience serving low-income and chronically ill populations. For more information, visit www.amerihealthcaritas.com.
About Pennsylvania Pharmacists Care Network
The Pennsylvania Pharmacists Care Network (PPCN) is a service of the Pennsylvania Pharmacists Association (PPA), the state's leading voice for advocating the profession of pharmacy and advancing the quality of patient care. PPCN is a network of pharmacists who are ready and willing to provide optimal care to their patients. Network pharmacists are committed to providing high quality, patient-centered care across the state. In collaboration with payers and providers, PPCN Pharmacists provide medication management services to patients ensuring appropriate medication use and improved health outcomes.
[i] Abstract 135: Low Income Patients With Diabetes: High Risk For Uncontrolled Hypertension? https://www.ahajournals.org/doi/10.1161/circoutcomes.6.suppl_1.A135