Keystone First Launches Initiative to Help Medicaid Members with Hypertension and Diabetes

Keystone First, a Blue Cross Medical Assistance (Medicaid) plan and the largest Medicaid plan in southeastern Pennsylvania, 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 215, mostly independently owned, community pharmacies in the state, to enhance member engagement and health services to improve patient health outcomes. PPCN will work with Keystone First to identify members with gaps in care based on their prescription fill history at a PPCN pharmacy. There are approximately 8,200 Keystone First members who would qualify for this program.

Joanne McFall, market president for Keystone First, said member engagement is essential in improving health outcomes.

“We are constantly looking for unique and innovative methods to expand access to quality health care for our members,” McFall said. “Working with local pharmacists will enable our care coordinators to better assess member needs and connect them to the services and supports needed for better health and wellness.”

When Keystone First 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 eligible 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 Brandon Antinopoulos, PharmD, PPCN’s President and Chief Operating Officer.

“Community pharmacists play an important role in caring for the medication-related needs of their patients, especially those with chronic health conditions,” he 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 Keystone First

Keystone First is a Medical Assistance (Medicaid) managed care health product offered by Vista Health Plan, Inc., an affiliate of Independence Blue Cross, in five southeastern Pennsylvania counties. Here at Keystone First, we are mission-driven and dedicated to helping members get care, stay well and build healthy communities. For more information, visit www.keystonefirstpa.com.

Independence Blue Cross and Vista Health Plan, Inc. are independent licensees of the Blue Cross and Blue Shield Association.

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 for the profession of pharmacy and advancing the quality of patient care. PPCN is a clinically integrated network of community pharmacies who 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.

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