(1237) Scaling Payer and Community Pharmacy Partnerships for Patient Care: A Qualitative Approach [the ACT (Academic-CPESN Transformation) Pharmacy Collaborative]

Objectives: The objective was to identify best practices for implementing patient care programs in collaboration with payers in order to scale-up these services across clinically integrated community pharmacy networks nationwide. Community pharmacy patient care programs have demonstrated positive clinical and economic impact. Practice transformation efforts through the Community Pharmacy Enhanced Services Networks USA (CPESN) has supported >100 state and national programs. Previous work of Academic-CPESN Transformation Pharmacy Collaborative (ACT) on Flip the Pharmacy (FtP) practice transformation program identified themes that lead to sustained program successes. However, program design, execution, and evaluation were identified as needing additional insight by program facilitators. Understanding elements of existing payer programs in order to establish best practices for continued partnerships between payers and clinically integrated networks of community pharmacies is necessary for scalability and sustainability.

Methods: This qualitative study consisted of a demographic survey and in-depth semi-structured interview with CPESN program facilitators of state and national payer programs. Eligibility criteria included one or more current payer programs and a minimum of 1-year experience. An interview guide was developed based on the Practical Implementation Sustainability Model (PRISM) framework and covered elements of planning and executing a payer program contract within community pharmacies. The PRISM framework provides a model for the evaluation of intervention implementation and sustainability. Online surveys and virtual semi-structured interviews were conducted from May to July 2023. Descriptive statistics were utilized to analyze the survey. The semi-structured interviews were audio-recorded and transcribed using Zoom. Transcripts were de-identified by a research team member. Rapid content analysis approach was used to analyze transcripts. Each transcript was summarized and validated by a research team member on a Microsoft Excel template based on the PRISM framework. All interview summaries were consolidated, and major themes were identified by the entire research team. The Institutional Review Board of the University at Buffalo approved this study.

Results: Fourteen program facilitators completed the survey and were interviewed. Most program facilitators had at least 4 years of experience and the average pharmacy network size was 119 ± 66.8. Program facilitators averaged 27 hours per week on total CPESN activities with 3.6 hours on payer engagement. A majority (57%) have at least 4 years of experience with the remaining having 3 years of less. Payer types by network included grants (78%), Medicaid (57%), and Medicare (53%). The semi-structured interviews resulted in themes surrounding best practices of developing and executing patient care programs within community pharmacies: 1) network adequacy is essential when engaging with payers; 2) programs need to align with the goals of the network, participating pharmacies, and the payers; 3) payment model needs to balance effort, outcomes, and return on investment to ensure pharmacies can financially sustain the program; 4) program facilitators have a vital role in the consistent communication with participating pharmacies and payers; 5) the network mainly determines training and ensures sufficient education and resources are provided; 6) networks should have continued program assessment based on data and pharmacy experience; and 7) data collection is a collaborative process between pharmacies and payers and should be used for continued quality assurance.

Conclusions: Program facilitators shared successful methods of collaboration with network pharmacies and payers. These findings can be utilized by clinically integrated network program leaders to implement and scale partnerships with payers for patient care programs in community pharmacies.