How and why CPOs should focus on population health

Medication mismanagement in the United States has become a $500 billion problem. And with pharmacy spend quickly outpacing other healthcare costs, networks need pharmacists on board to manage population health with fewer expenses.

Dispensing, of course, will always be a core pharmacy focus. But a growing number of pharmacy leaders are adding population health as a core responsibility, too.

That’s because population-level pharmacy management defrays the use of higher-cost resources. How? It starts with gathering patient data. Then, care teams can turn that data into efficient, effective plans of care that improve outcomes throughout the network. 

Here, I’ll explain how and why CPOs should prioritize population health.

1. Better medication reconciliation and management

When it comes to population health management, med rec isn’t just about achieving a quality score. It’s a clinical imperative.

On an individual level, poor med rec can be costly. For example, a patient on simvastatin might visit a new provider to discuss COVID-19 treatment. But without access to an accurate medication history, the provider may prescribe Paxlovid – which can quickly trigger an adverse reaction and result in hospitalization.

That’s a problem – and for more than the hospitalized patient, too. Inefficient med rec costs money for patients and providers throughout the network. 

Other cardiovascular patients are likely to need Paxlovid, for example. And though they may all visit the same cardiology clinic, it’s unlikely they all share the same PCP. So the error can repeat, putting multiple patients at avoidable risk.

But with population health as a priority, CPOs and their teams can review medication histories to make sure they’re accurate for all empaneled patients under their care. And when necessary, pharmacists can reach out to double-check whether a new medication has been added. Or whether a treatment has been abandoned altogether.

Ultimately, population-focused CPOs can drive higher-quality, better-value care – and see better outcomes throughout the network.

2. Lighter administrative workloads for physicians

We’ve written before about prior authorization roadblocks. Overburdened physicians often struggle to efficiently review patients’ health plans and stay up to date on formularies.

Without the right support, a physician may default to prescribing the medications they know, like Lisinopril for patients with hypertension. But Lisinopril may trigger the prior authorization process if it isn’t on formulary.

Navigating this process can unnecessarily eat up a provider’s time – a critical resource when it comes to population health management. What’s more, it may result in delayed or cost-prohibitive access to treatment, a major driver of patient nonadherence.

Population-minded CPOs understand the gravity of these consequences. Overstretched physicians are already without adequate time for each patient. Further complicating that restriction with bureaucracy can slow down the delivery of care for patients throughout the network.

But with access to a robust pharmacist network, care teams can more efficiently handle prior authorizations for an entire population. RxLive’s pharmacist partners can leverage their deep formulary knowledge to identify generic drugs and alternatives, like biosimilars. This reduces providers’ workloads by avoiding the prior authorization process where possible.

At every stage, pharmacists can flag key insights (say, a viable generic or med rec error) for providers. With this support, physicians can spend more time with patients – and patients can get faster, more effective (and therefore affordable) treatment.

3. Fewer readmissions via tech-powered prevention

Readmissions are costly for networks – roughly 75 percent of hospitals will receive readmission penalties in FY 2023.

For CPOs, it’s clear that dispensing activities alone isn’t lowering readmissions. But a population health mindset can.

Population-focused pharmacy leaders can account for and address a range of health determinants, from race and ethnicity to socioeconomic status. And with the right tech, pharmacists can more narrowly target the causes of readmission – like a patient not filling prescriptions they can’t afford. This way, networks can avoid stopgap solutions and help solve the structural issues that impact patients’ health.

RxLive software enables pharmacists to…

  • Identify patients at the highest risk of readmission.
  • Regularly communicate with high-risk patients to discuss the value of med adherence and address key barriers.

The benefits: a statistically significant reduction in readmissions, which improves patient outcomes while lowering penalties for providers.

Effective population health management depends on pharmacists

An effective population health strategy can reduce hospitalizations and lead to healthier patients in aggregate. And with tech-enabled pharmacists, networks can efficiently improve population health while mitigating costs.

In an equity-focused world, this approach is critical. As people suffer from the mounting impact of generational health disparities, integrated care teams can leverage a population health focus to positively impact patients and communities.

If you’re interested in learning more about how RxLive can power pharmacists, we’d love to start a conversation.

Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.