Innovative Programs and Partnerships Yield Improved Pharmacy Quality and Patient Outcomes
With a growing shortage of Primary Care Access, innovative programs leveraging a patient’s pharmacy are starting to show beneficial outcomes in moving the quality needle. With 65% of counties experiencing a relative Primary Care Provider shortage having up to the top third of pharmacy availability1, and most patients visiting their pharmacy up to 12x more often than their doctor each year2, RxAnte took a creative approach to improving patient quality and outcomes by leveraging the pharmacy in a comprehensive, data-driven program.
A value-based pharmacy program has great success when the right partners come to the table in the right way. By analytically targeting members most likely to benefit from pharmacy care management, structuring value-based incentives to reward engagement with at-risk members, patients can see improved health outcomes delivered efficiently and effectively and health plans can optimize their intervention approach and spend.
Partnering with Centene, a 50-state health plan with over 28.5 million members, a program was designed to optimize the role, efficiency, and effectiveness of a value-based care pharmacy intervening with a patient to ensure medication adherence and care gap closure.
RxAnte’s patented analytics helped Centene and their value-based pharmacies understand member behavior through predictive modeling, focusing in on patients in a more targeted, high impact way. Through leveraging proprietary analytics, RxAnte is able to simulate a multitude of outcomes, allowing clients to better understand the expected outcomes at different spending amounts. When clients provide their goals, RxAnte can strategically target patients based on those goals. Progress was tracked through actionable data and performance metrics, and pharmacies were incentivized to engage with the highest impact at-risk members.
In order to be successful, Centene had to build strong relationships with their value-based pharmacy network to recruit pharmacies to engage with the program and educate them on program deployment. Key elements to success were frequent engagement with members, in-depth conversations to uncover underlying barriers, and a strong, targeted analytics strategy.
The program found pharmacy activity rating was correlated with adherence improvement (See Table 1, Chart 1).
Table 1: Pharmacy engagement and opportunity deployment drives lift for MAPD, largest lift observed in the highly active pharmacies.
Chart 1
Most importantly, the program drove meaningful improvement at the population level (See Chart 2). Active pharmacies contributed +1% of population level adherence improvement, and across all three adherence measures, Centene outperformed compared to industry.
Chart 2
One unique value-based pharmacy partnership developed to improve outcomes for the most challenging patients at Centene is through RxAnte’s pharmacy, Mosaic Pharmacy Service, which cares for the most medically complex, challenging patients through a world class experience. The Centene patients Mosaic manages are on average taking 9 chronic medications, have a 2x higher HCC risk score, 86% reside in moderately to highly disadvantaged zip codes per Area of Deprivation Index, 58% have some level of low-income subsidy, and 29% are <65 years of age with disabling chronic conditions.
Mosaic Pharmacy Service combines the analytic power behind RxAnte with a clinically high-touch pharmacy model, complete with adherence packaging delivered to patients monthly, to improve patient adherence, health outcomes, and provide a great experience. The complex Centene MAPD members enrolled with Mosaic achieved 5-Star performance across each of the Part D measures in 2024 (See Infographic 1).
Infographic 1
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Maaria Kheiri, PharmD, Director of Pharmacy Quality Improvement at Centene Pharmacy Services, and Jeff DiGeronimo, BS, Vice President of Program Strategies and Client Success at RxAnte, presented a PQA webinar to review two proven value-based pharmacy models: a community pharmacy incentive program and a comprehensive care management program for complex and vulnerable seniors.
- Dworkin J. Pharmacists Help To Manage the Shortage of Primary Care Providers. Remote Care Partners. Published April 2024. Accessed March 31, 2025. https://www.remotecarepartners.com/pharmacists-help-to-manage-the-shortage-of-primary-care-providers/
- Qato DM, Zenk S, Wilder J, Harrington R, Gaskin D, Alexander GC. The availability of pharmacies in the United States: 2007-2015. PLoS One 2017;12(8):e0183172.