2025 Southeastern Residency Conference

Title: Evaluation of Ambulatory Pharmacist Interventions in Patients with Type 2 Diabetes and Medicaid Managed Care Contracts
Authors: Layna Fox, Kaleigh Mikolichek, Julie Pruitt, Catie Harper
Objective: At the conclusion of this presentation, the participant will be able to describe a population health intervention to address care gaps in patients with Medicaid Managed Care plans.
Self Assessment Question: According to this data, where do you feel pharmacists can contribute value to this population of patients? A) Improving adherence, B) Encouraging use of guideline-directed therapy, C) Providing telehealth follow-up for high-risk patients, D) All of the above
Background: North Carolina launched Medicaid Managed Care plans in July 2021, and expanded Medicaid access to adults earning up to 138% of the federal poverty limit on December 1, 2023. Medicaid Managed Care contracts involve value-based care quality measures for disease state control for chronic conditions, including diabetes and hypertension, which influence health system reimbursement. Despite having insurance, patients with Medicaid face substantial barriers to accessing healthcare including financial limitations and transportation. The purpose of this study was to evaluate the impact of proactive pharmacist intervention on quality measures and access to care among patients with type 2 diabetes (T2D) that were newly eligible for Medicaid Managed Care plans. 
Methods: This was a single-center, prospective, pre-post matched, IRB-reviewed and exempt cohort analysis that included patients with T2D with initiation of a Medicaid Managed Care plan December 1, 2023 through August 30, 2024 that were engaged by an embedded pharmacist at a Cone Health Primary Care clinic. Eligible patients were identified through a monthly report and scheduled with the appropriate clinic-based pharmacist, who then worked with the patient and their primary care provider to manage T2D and associated disease states. Demographics, medications, and clinical data at baseline prior to pharmacy engagement and at most recent follow-up, through December 31, 2024, were collected via chart review. The primary outcome was percent of patients meeting Medicaid quality metrics for diabetes (A1c < 9%) and hypertension (BP <140/90 mmHg) after pharmacist intervention compared to baseline. The primary outcome was assessed using a McNemar’s Chi-Square test. Baseline characteristics and secondary outcomes were reported with descriptive statistics. 
Results: There were 63 patients engaged over 184 pharmacy appointments during the study period. Pharmacists utilized telehealth during the initial encounter for 45 (71.4%) patients. There were 31 (49.2%) female patients and 30 (47.6%) patients who identify as Black or African American. The mean age was 51.7 years and mean baseline A1c was 9.9%. Most patients reported a social determinant of health barrier. At baseline, 21 (33.3%) patients were achieving the primary composite outcome of A1c < 9% and BP < 140/90 mmHg, which increased to 39 (61.9%) patients at the end of the study period (difference 28.6%, 95% confidence interval 11.5%-45.7%, p = 0.001).  The median time between first pharmacist engagement and last follow-up through December 2024 was 202 days (IQR 158 days). The most common medication therapy problem identified by pharmacists was adherence in 82.5% of patients, and the most common drug therapy interventions were medication counseling, adjusting pharmacotherapy, and assisting in access to care. 
Conclusion: Proactive pharmacist intervention in patients with Medicaid Managed Care contracts positively contributed to patients’ access to care, disease state management, and health system performance on Medicaid quality measures for diabetes and hypertension control.