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PQS and Humana achieve noteworthy success in diabetes outcomes pilot

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DURHAM, N.C. Pharmacy Quality Solutions (PQS) and Humana,announced that their 2020 innovative diabetes outcomes-based pilot program has resulted in significant improvement in measurable patient outcomes and will expand to additional pharmacies nationwide in 2021.

“Humana continues to emphasize innovation in value-based care models and to engage with pharmacists who are on the front line of patient care,” said Bethanie Stein, Humana Pharmacy Solutions President of PBM Services. “Our pilot saw a remarkable increase in patients meeting A1C goals and completing an A1C test. These results are a testament to the collaboration with pilot pharmacies and PQS. We look forward to engaging with more pharmacies and expanding their services in our diabetes outcomes program.”

Humana and PQS designed the pilot program to reward pharmacists across six states last year for improving health outcomes of Humana Medicare Advantage members with diabetes. Critical to the pilot’s success is PQS’s EQuIPP platform, which provides pharmacists with access to patient data, including lab values and testing information, and the ability to document patient encounters. Samantha Davis, a pharmacist at Cherokee Drug in Newport, Kentucky, said, “The EQuIPP dashboard gave my pharmacy a more complete picture of our patients and made it easier to track patient progress and performance.”

“Seeing the innovative Humana program in EQuIPP is evidence that value-based care is becoming a reality,” said James Kirby, Senior Director for The Kroger Co. “Community pharmacists, like those at Kroger Health, are uniquely equipped to manage the health of populations, and Humana is compensating us [pharmacists] for doing it well. We appreciate the role PQS played in creating positive partnerships between pharmacies and payers as well as their flexibility to deliver the data necessary to bring the program to life.”

PQS continues to expand its library of quality measures, going beyond adherence to include measures impacting the medical benefit. Humana will include some of these additional measures, such as Retinal Eye Exam Complete, with the program expansion.

“PQS has always recognized the power of the community pharmacy to support greater patient outcomes and has advocated for the shift in value-based reimbursement opportunities,” says Todd Sega, CEO at PQS. “With the increased awareness of community pharmacy’s potential, PQS continues to be a strong supporter for the expansion and acceleration of similar outcomes-based programs.”


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