Below are answers to some of the most frequently asked questions about HealthMapRx:

Q: What does this program do for patients with chronic conditions?
A: HealthMapRx is a consumer incentive program that focuses on the idea of patient self-management education and techniques to help patients with chronic conditions improve health outcomes.  The program matches patients to community pharmacist “coaches” who provide hands-on education, monitoring, and evaluation of health improvements.

Stakeholder Participation

Q: What is the role of my Pharmacy Benefit Manager (PBM) in the HealthMapRx program?
A: Since PBMs are primarily responsible for processing and paying prescription drug claims, employers will be required to work with their PBM to waive enrollee medication co-pays.  Employers will also communicate with their PBM to reinstate medication co-pays if an enrollee drops out of the HealthMapRx program.  About once a year, the PBM will also provide a prescription claims report to HealthMapRx for all of the employer’s plan beneficiaries participating in HealthMapRx. 

Q: Should an employer collaborate with its health plan/carrier in addition to its PBM?
A:  Yes, it is important to include health plans/carriers in this program.  The health plan is responsible for providing medical claims data for analysis on a yearly basis during this program (the employer will need to request this data from its health plan).  Otherwise, there are minimal efforts required by an employer’s health plan/carrier.

Q: What are the data specifics necessary to identify the population for enrollment?
A: The easiest way to get the information needed to identify the population for enrollment in HealthMapRx is to ask your PBM to run a zip code analysis of where people who are getting prescriptions for diabetes medications live. 

Program Enrollment

Q: How do participants enroll in the program?
A:  The employer will host orientation sessions for employees to learn about the HealthMapRx program and will provide enrollment packets for interested employees.  A participant must agree to the terms included in the enrollment packet in order to receive waived co-pays and any additional incentives.  The employee will complete the forms enclosed in the enrollment packet and return it to the HR/Benefits Department, or other designated department, so that the necessary administrative items can be processed to alter the employee’s benefits structure.

Q: How are patients matched to a pharmacist provider?
A: The participants are asked to select a first, second, and third choice pharmacist from the Pharmacist Directory.  The Network Coordinator will then make assignments based on the rank choice and the number of participants a pharmacist has agreed to see.  Sometimes this is negotiated depending on the availability of providers and location of the participant.

Pharmacist Participation and Services

Q: What services do pharmacists provide to HealthMapRx™ participants?
A: Pharmacists follow the ADA guidelines when evaluating the health status of diabetic patients. Using these guidelines, pharmacists set incremental health goals with the patient. In addition, pharmacists work with patients to set lifestyle goals in nutrition, exercise, and weight control. Pharmacists will measure A1C levels, cholesterol levels, and blood pressure. Regular eye and foot exams will be administered, along with an annual flu shot.

Q: Why are pharmacists used as coaches in the HealthMapRx program?
A: Implementing HealthMapRx involves collaborative efforts between multiple stakeholder groups: employers, pharmacist providers, patients, nurses and physicians.  The Pharmacist Network Coordinator engages and aligns these stakeholders in their efforts to achieve the common goal of improving health outcomes for people with chronic disease.

Pharmacists serve as the catalyst for HealthMapRx's patient-centered program approach.  Referred to as “coaches” or “mentors,” these pharmacists meet regularly with individuals to evaluate health status and establish incremental goals to improve health outcomes.  Because individuals with chronic conditions are more likely to have multiple prescription medications, the pharmacist represents an ideal vehicle for counseling patients on a frequent basis.  Pharmacists are experts in medication management, working with individuals to ensure their medication therapy is optimal and properly managed.

Q: What kind of training do HealthMapRx Pharmacist Coaches receive before counseling diabetic patients?
A: Pharmacists participating as coaches in the HealthMapRx program must participate in the APhA Diabetes Certificate Training Program. The APhA Diabetes Certificate Training Program is an innovative and intensive certificate program that focuses on the pharmacist's role in the area of diabetes management. The program, which emphasizes a health care team approach, seeks to foster the implementation of pharmaceutical care interventions that will promote disease self-management. The program is accredited by the American Council on Pharmaceutical Education. Pharmacists may also participate in online programs through several schools of pharmacy. These online programs are supplemented by live skills training sessions and case studies.

Pharmacist Visits

Q: How often will HealthMapRx participants meet with their pharmacist coach?
A: Typically, a patient meets with the pharmacist on a monthly basis for the first three months of the program, and quarterly thereafter, unless otherwise directed by the pharmacist or employer. During the first few visits, the patient must complete a knowledge and skills assessment - the pharmacist will then determine their level (beginner, proficient, advanced). At this time, if the pharmacist feels that the patient requires additional education about diabetes, they will likely be referred to a diabetes education center to learn more. 

Q: Where do HealthMapRx coaching sessions take place?
A: The coaching sessions take place in designated, private counseling locations, which include community pharmacies, the workplace, or other specified locations.

Q: How are diabetic patients who are using naturopathic treatments instead of traditional medicines treated in the HealthMapRx program?
A: Patients using naturopathic treatments for their diabetes should be encouraged to participate in the HealthMapRx program.  Pharmacist coaches are able to work with providers, both alternative and traditional, to improve a patient’s continuity of care. Pharmacist coaches will document a patient’s chart tracking potential herbal remedies and other holistic medicines that may impact adherence and care.  This patient-pharmacist interaction is critical especially because patients may be receiving both western and alternative medications that could potentially interact.  Along with counseling participants on proper medication use, pharmacists will coach HealthMapRx participants (on both traditional and naturopathic regimens) on lifestyle changes that will help improve their chronic conditions.   

FAQs from Third Party Administrators (TPAs)

Q: How involved is HealthMapRx?
A: The HealthMapRx program requires a minimal time commitment from TPAs. A turn-key solution provided by HealthMapRx LLC, HealthMapRx materials have been developed to help TPAs communicate and explain the program internally.  The frequency of data pulls is low and the HealthMapRx LLC provides dedicated contact(s) to help address carrier concerns and questions. 

Q: How am I going to “sell” this internally?
A: HealthMapRx materials have been developed to explain the program to internal audiences.  Others are also able to assist in “selling” the program with very little internal strife – your Pharmacy Benefit Manager (PBM) may already be implementing HealthMapRx in another region. 

Q: What’s in it for me?
A: There is an increased customer satisfaction with those TPAs/PBMs willing to assist with HealthMapRx requirements.  HealthMapRx reduces costs through decreased hospital and emergency room visits.

FAQs from Physicians

Q: Will this program demand more time on the part of the physician and are physicians compensated for this time?
A: No. The pharmacist is responsible for assisting in carrying out the physician’s already established plan of care for the diabetic patient. Realizing that physicians (especially primary care providers) are overworked and often pressed for time, the pharmacist serves as the support or extension of the physician to provide care services to the patient.  Physicians are not compensated through this program for conducting additional visits based on referrals, but will be compensated for additional visits through health insurance claims currently fulfilled by carriers.

Q: How often do the pharmacists communicate with the patients’ physicians? 
A: Pharmacists are required to communicate with physicians after each patient visit.  Typically, pharmacists introduce themselves to the patient’s physician and explain their role in the process of care.  The pharmacist will request a copy of the patient’s file and lab results from the physician upon introduction as this will be a basis for health evaluation. 

Q: Is there any follow up required on the part of the physician back to the pharmacist?
A: The HealthMapRx program is intended to foster collaborative communication between healthcare providers in the community.  Follow up is encouraged, but not required.

Q: Do the Pharmacists request patient medical records?  If so, what is the payment method for that? 
A: Pharmacists do not request patient medical records from physicians.  After patients sign a consent form to share information, the physician’s goals for the patient’s diabetes care and recent lab values related to diabetes, such as A1c and Lipid Profiles will be requested.