Humana Inc. Healthy Horizons in Ohio and CPESN USA Introduce Value-Based Pharmacist Quality Rewards Program to Improve Chronic Disease Care
Humana Inc., through its Medicaid plan Humana Healthy Horizons in Ohio, has announced an expanded collaboration with CPESN USA aimed at improving access to care and health outcomes for individuals living with chronic conditions. At the center of this initiative is the launch of the first Pharmacist Quality Rewards program in the state, a value-based care (VBC) model designed to incentivize community pharmacists to play a more active role in managing chronic diseases such as hypertension and diabetes.
This program represents a strategic evolution in how healthcare services are delivered at the community level. By recognizing pharmacists as essential contributors to patient care, the initiative seeks to bridge gaps in treatment, enhance care coordination, and ultimately improve clinical outcomes for Medicaid members across Ohio. The model builds upon an existing partnership between Humana Healthy Horizons and CPESN-affiliated pharmacies, introducing financial incentives tied directly to measurable quality outcomes.
Kathie Mancini, President of Humana Healthy Horizons in Ohio, emphasized the importance of pharmacists in the broader healthcare ecosystem. She noted that community pharmacists are uniquely positioned to support individuals with chronic conditions because of their frequent interactions with patients and their deep integration within local communities. Unlike traditional care settings where patients may see physicians only a few times per year, pharmacies often serve as consistent and accessible points of contact for ongoing health management.
The Pharmacist Quality Rewards program is structured around a value-based care framework, which shifts the focus from volume of services to the quality and effectiveness of care delivered. In this model, participating CPESN pharmacies are rewarded for achieving specific performance metrics aligned with improved patient outcomes. The program was developed through close collaboration between Humana, CPESN USA, and a range of internal stakeholders, including clinical, pharmacy, and population health teams.
At its core, the initiative targets individuals managing hypertension and diabetes—two of the most prevalent chronic conditions in the United States. These conditions often require long-term medication adherence, регуляр monitoring, and lifestyle adjustments. Because patients with these conditions frequently visit pharmacies to refill prescriptions, pharmacists have a valuable opportunity to engage with them on a regular basis, identify potential gaps in care, and provide timely interventions.
Through the program, participating pharmacists receive actionable data that enables them to identify patients who may be missing recommended screenings or whose clinical indicators fall outside of target ranges. For example, a pharmacist may be alerted if a patient has not recently undergone a blood pressure check or hemoglobin A1c test. Armed with this information, pharmacists can proactively engage patients during routine visits, encouraging them to complete necessary tests and offering point-of-care services when available.
One of the key advantages of this approach is the ability to deliver care at the point of interaction. Many CPESN pharmacies are equipped to perform on-site testing, such as blood pressure measurements and A1c assessments, allowing patients to receive immediate feedback without the need for additional appointments. When abnormal results are identified, pharmacists can communicate directly with prescribing physicians, ensuring that appropriate follow-up care is initiated.
The program’s performance metrics are aligned with nationally recognized quality standards established by the National Committee for Quality Assurance through its Healthcare Effectiveness Data and Information Set (HEDIS). These measures include Controlling High Blood Pressure (CBP), Glycemic Status Assessment for Patients with Diabetes (GSD), and Blood Pressure Control for Patients with Diabetes (BPD). By tying financial incentives to these benchmarks, the program encourages pharmacies to focus on interventions that have a measurable impact on patient health.
Early results from participating CPESN pharmacies in Ohio highlight the potential effectiveness of this model. One example comes from Medicine Center Pharmacy in New Philadelphia, where pharmacists identified several Humana Healthy Horizons members with hypertension who had not received recent blood pressure monitoring. By offering same-day testing and personalized counseling during routine prescription pick-ups, the pharmacy was able to reconnect these patients with essential care services.
Angela Rademacher, PharmD, a clinical lead at the pharmacy, noted that pharmacies often represent the most accessible point of care for many patients. She explained that by meeting patients where they already are, pharmacists can engage in meaningful conversations about health, identify unmet needs, and collaborate directly with prescribers to improve outcomes. This approach not only enhances patient engagement but also strengthens the overall continuum of care.
Troy Trygstad, PharmD, MBA, PhD, Executive Director of CPESN USA, underscored the broader significance of the program. He highlighted CPESN’s mission to bring together payers, pharmacies, and communities to deliver locally driven, value-based care. According to Trygstad, the Pharmacist Quality Rewards program demonstrates how community-based pharmacies can play a pivotal role in improving healthcare quality and addressing the needs of individuals living with chronic diseases.
The initiative also reflects a growing recognition within the healthcare industry of the importance of interdisciplinary collaboration. By integrating pharmacists more fully into care teams, programs like this one aim to improve communication between providers, reduce fragmentation in care delivery, and ensure that patients receive consistent and coordinated support.
For Humana, the program aligns with a broader commitment to advancing value-based care models that prioritize outcomes, patient experience, and cost efficiency. By incentivizing pharmacists to engage in proactive care management, the company aims to reduce barriers to care, improve adherence to treatment plans, and ultimately enhance the quality of life for its members.
In addition to improving individual patient outcomes, the program has the potential to generate broader system-level benefits. Effective management of chronic conditions can reduce the incidence of complications, hospitalizations, and emergency department visits, leading to lower healthcare costs and more sustainable care delivery. By leveraging the accessibility and expertise of community pharmacists, the initiative offers a scalable approach to addressing some of the most pressing challenges in chronic disease management.
Looking ahead, the partnership between Humana Healthy Horizons and CPESN USA may serve as a model for similar programs in other regions. As healthcare systems continue to evolve toward value-based frameworks, the role of community-based providers is likely to become increasingly important. Programs that empower pharmacists to take on expanded responsibilities in patient care could play a critical role in shaping the future of healthcare delivery.
Overall, the launch of the Pharmacist Quality Rewards program in Ohio represents a significant step forward in integrating pharmacists into value-based care models. By aligning financial incentives with quality outcomes and leveraging the unique position of community pharmacies, the initiative aims to improve care for individuals with chronic conditions while strengthening the healthcare system as a whole.
About Humana
Humana (NYSE:HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.
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