Summary: This blog post explores how Medicaid pharmacists leverage innovative strategies and actionable insights for improving medication adherence, driving value-based care, and enhancing population health outcomes.
Improving Medication Adherence & Population Health Outcomes
Medicaid pharmacists play a critical role in value-based care models by implementing pharmacist-led population health strategies that improve medication adherence, drive treatment outcomes, and enhance patient well-being for vulnerable populations.
At aPHP, we define a pharmacist-led approach to population health as population health pharmacy—an integration of clinical expertise, data-driven strategies, and public health principles to strengthen healthcare frameworks and improve population-wide outcomes.
This approach focuses on:
Improving medication adherence
Increasing medication access
Bridging care gaps to drive health equity beyond traditional pharmacist roles
Reducing healthcare costs while improving long-term patient outcomes
Examples of Traditional Pharmacist Roles (Post-1951)
Compounding
Dispensing Medications
Hospital Rounds
Immunizations
Medication Reconciliation
Medication Safety Review
OTC Subject Matter Expertise
Patient Counseling
Pharmacy Operations
Changing Role: From Dispensing to Direct Patient Care
Historically, pharmacists served as central care providers, playing a direct role in patient care, chronic disease management, and medication therapy. However, the 1951 Durham-Humphrey Amendment redefined pharmacy’s role, shifting many patient care responsibilities into physician-led models and limiting pharmacists’ ability to provide direct interventions (Fig. 1).
Today, Medicaid pharmacists are reclaiming their role in healthcare through population health strategies that improve medication adherence, access, and policy-driven interventions. Their work reinforces evidence-based practices and restores the pharmacist’s place in advancing public and population health initiatives.
As pharmacist-driven programs continue to gain traction, Medicaid pharmacists are pivotal in closing health gaps, implementing value-based care strategies, and ensuring measurable patient outcomes.
This blog post explores how Medicaid pharmacists leverage innovative strategies and actionable insights for improving medication adherence, driving value-based care, and enhancing population health outcomes.
Figure 1. Summarizes the impact of the Durham-Humphrey Amendment, highlighting pharmacy’s shift from autonomous prescribing to a restricted dispensing role, its effects on patient care, and ongoing reforms restoring pharmacist prescribing.
Why is Population Health Important?
Population health is a patient-centered approach aimed at improving health outcomes across entire populations by addressing systemic barriers, chronic disease management, and healthcare disparities.
Unlike traditional models focused on individual patient encounters, population health emphasizes preventative care, risk stratification, and coordinated interventions to reduce avoidable hospitalizations and long-term healthcare costs.
Medicaid pharmacists, serving as population health pharmacists (PHPs), are at the forefront of this shift—leveraging data-driven strategies, medication adherence programs, and interdisciplinary collaboration to improve population-wide health outcomes.
Why Population Health Matters:
Expands access to care by identifying and addressing social and economic barriers that impact underserved populations.
Improves chronic disease management through long-term adherence programs and pharmacist-led interventions.
Strengthens healthcare infrastructure by integrating community-based interventions and pharmacist-driven strategies.
Medicaid pharmacists play a critical role in this framework, applying evidence-based adherence strategies—such as Medicaid Adherence Telepharmacy Programs—to improve treatment outcomes and support broader public health goals.
What is Value-Based Care?
Value-based care (VBC) is a healthcare payment model that prioritizes patient outcomes over service volume. Instead of reimbursing providers based on the number of services rendered, VBC ties reimbursement to quality metrics such as medication adherence, chronic disease management, and overall health improvements.
As healthcare systems shift toward cost efficiency and quality-based reimbursement, Medicaid pharmacists play a pivotal role in:
Enhancing medication adherence, a key metric in value-based contracts.
Leveraging real-world to enhance treatment decisions and policy implementation.
Since value-based care depends on proactive, pharmacy-driven strategies, Medicaid pharmacists are uniquely positioned to reduce healthcare costs while improving long-term patient outcomes.
Key Goals of Value-Based Care:
Enhancing provider accountability through evidence-based, patient-centered care by optimizing prescribing and deprescribing practices.
Improving patient outcomes through preventative care and holistic health strategies.
Reducing preventable hospitalizations through medication therapy management (MTM).
As VBC continues to expand, Medicaid pharmacists play a leading role in driving measurable health improvements—solidifying pharmacy’s position as a key player in healthcare transformation.
What Role Does Population Health Play in Value-Based Care?
Since value-based care focuses on improving long-term health outcomes while lowering costs, population health strategies are essential for ensuring measurable success across entire patient populations.
Medicaid pharmacists serve as a bridge between value-based care and population health, integrating pharmacy-led interventions within managed care, health systems, and public health initiatives. Their role in medication adherence, formulary management, and chronic disease interventions helps optimize treatment success and reduce healthcare disparities.
How Medicaid Pharmacists Drive Population Health in VBC:
Expand pharmacist-led preventative strategies at a population level.
Bridge care gaps between managed care organizations and public health initiatives.
Use data analytics to identify population trends and implement targeted interventions.
Integrating Real-World Impact: The Work of Dr. La Kesha Y. Farmer
Dr. La Kesha Y. Farmer, founder of aPHP, has direct expertise in this space, having successfully led multiple Medicaid Clinical Pharmacy Adherence Outreach Programs as a PHP within a Managed Care Organization (MCO).
Through her leadership, medication adherence programs advanced, helping to reduce treatment gaps and support long-term health improvements.
As part of broader efforts, her initiatives contributed to measurable cost savings, reinforcing the value of pharmacists in optimizing Medicaid outcomes.
Studies further validate the impact of Medicaid pharmacists in driving adherence improvements within MCOs, supporting the effectiveness of pharmacist-led interventions.⁵
By integrating population health pharmacy into value-based care, pharmacists bridge the gap between managed care organizations, public health initiatives, and patient-centered interventions—ultimately improving population-wide outcomes.
Improving Medication Adherence via HEDIS, Advocacy, and Beyond
Medicaid pharmacists go beyond traditional medication therapy management (MTM), leveraging policy-driven interventions and Medicaid-specific adherence strategies to drive measurable improvements in medication adherence. Their work focuses on:
HEDIS Measures: Leveraging Data for Optimal Outcomes
Enhancing Patient Access and Experience
Empowering Patients Through Tailored Education
Leveraging Technology to Improve Adherence
Optimizing MTM for Medicaid Populations
Addressing Social Determinants of Health (SDOH)
Each section below will explore how Medicaid pharmacists drive measurable impact in these areas to improve medication adherence and patient outcomes.
HEDIS Measures: Leveraging Data for Optimal Outcomes
As part of population health pharmacy initiatives, Medicaid pharmacists play a critical role in improving medication adherence by leveraging claims data and metrics to identify and assist non-adherent members and drive measurable outcomes.
An example of metrics include the Healthcare Effectiveness Data and Information Set (HEDIS), a set of quality measures established by the National Committee of Quality Assurance (NCQA)
Real-world programs like the Targeted Intervention Program™ (TIPs) showcase how HEDIS-driven pharmacist interventions enhance clinical performance.⁸
These programs support Medicaid beneficiaries in meeting national health objectives while also providing valuable prescribing insights, such as drug utilization reviews (DURs), to optimize medication use and improve patient safety.
Enhancing Patient Access and Experience
Medicaid pharmacists enhance patient experience by ensuring beneficiaries receive optimized, cost-effective care.¹ This includes identifying barriers, triaging patient-provider concerns, and facilitating connections to preferred providers.
These efforts align with the Agency for Healthcare Research and Quality’s (AHRQ) Consumer Assessment of Healthcare Providers and Systems (CAHPS) program, which prioritizes patient-centered care and experience-driven provider selection—both key factors in Medicaid quality initiatives.
Empowering Patients Through Tailored Education
Medicaid pharmacists deliver personalized education that reinforces how medication adherence directly impacts the management of chronic conditions like diabetes, hypertension, and asthma, helping patients achieve improved health outcomes.
By building trust and using culturally competent communication, they empower patients to take control of their health— defined by the World Health Organization (WHO) “as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.”
Recent research highlights the critical role of pharmacist-led deprescribing in improving medication safety for patients with chronic diseases.
A pharmacist-led intervention study found that patients receiving pharmacist-driven deprescribing support had a median of one medication deprescribed, while the control group experienced an average increase of 0.44 medications.²
Notably, patients with heart failure in the intervention group showed significant improvements in ejection fractions.²
Pharmacists already implement simple yet effective tools—medication guides, consultations, and targeted interventions—to improve patient understanding and medication adherence.
Their role in deprescribing and education is undeniable, yet studies like this underscore the necessity of pharmacist-inclusive practices over exclusion—a pattern repeatedly observed, most recently in the GeriPal super studies and many others before it.
Leveraging Technology to Improve Adherence
Medicaid pharmacists integrate digital health tools into patient care, harnessing technology as a vital strategy for improving medication adherence.
These innovations enhance patient engagement, streamline provider communication, and address adherence barriers.
Key examples include:
Adherence Reminder Apps: Help patients stay on track with medication schedules.⁶
Telehealth Services: Facilitate real-time, remote consultations to identify and resolve adherence challenges efficiently.⁶
Mobile health (mHealth) tools: Devices such as smartphones, blood pressure monitors, and wireless scales provide timely reminders and enhance patient-provider communication.⁶
By leveraging these digital solutions, Medicaid pharmacists drive sustained medication adherence, leading to improved health outcomes in Medicaid populations.
Optimizing MTM for Medicaid Populations
Medicaid pharmacists leverage managed care frameworks and formulary management to enhance adherence and resolve prior authorization issues, reducing costs. They streamline adherence through packaging and refill coordination.
Beyond adherence, MTM serves as a bridge to care by addressing patient-specific barriers and integrating pharmacy services into broader healthcare initiatives.
Addressing Social Determinants of Health (SDOH)
Medicaid pharmacists play a critical role in addressing barriers to care—such as SDOH—by helping MCOs bridge care gaps and reduce disparities that contribute to poor medication adherence.¹
Medicaid pharmacists, as integral members of the healthcare team, work collaboratively with a diverse group of stakeholders to effectively address SDOH-related challenges that impact medication adherence, ensuring more equitable healthcare access and improved health outcomes.
6 Key SDOH Initiatives Where Medicaid Pharmacists Play a Vital Role:
Care Coordination.
MCOs have integrated community health workers (CHWs) into health plans, enabling Medicaid pharmacists within these organizations to train CHWs as pharmacy liaisons, supporting medication adherence, retention, and continuity of pharmaceutical care.
Diet and Transportation Support.
Collaborating with community-based organizations (CBOs) to offer transportation assistance and connect patients with Food Rx programs,¹ such as Produce Prescriptions Programs (PRx), which address food insecurity while promoting dietary habits that support chronic disease management goals.
Holistic Care Programs.
Facilitating whole person care using programs like California’s Advancing and Innovating Medi-Cal (CalAIM) to improve care support and address broader health needs.
Medication Access.
Activating prescription delivery services removes access barriers, ensuring patients receive medications without mobility or transportation challenges.¹
Closed-Loop Referrals.
Utilizing platforms like 211 or FindHelp.org to facilitate closed-loop referrals—ensuring patients are successfully connected to essential social services and that healthcare providers receive confirmation of completed referrals, removing barriers that interfere with medication adherence.
Workforce Training.
Research supports SDOH-focused training for pharmacy interns and technicians to assess social needs and adherence barriers.³ Medicaid pharmacists, including Dr. Farmer, have implemented similar strategies in managed care, reinforcing the impact of pharmacist-led SDOH initiatives in population health pharmacy.
How Medicaid Pharmacists Advance Health Equity & Influence Policy
Medicaid pharmacists function as Medicaid Champions, leading policy initiatives by analyzing adherence trends and presenting actionable recommendations to Medicaid policymakers and program leaders.
Their advocacy addresses systemic barriers—such as formulary restrictions, copay challenges, and access limitations—ensuring access to care remains a priority while improving medication adherence.⁷
By shaping policies that eliminate disparities, their leadership advances equitable care and drives systemic change.
Dr. Farmer exemplified this impact by presenting her clinical pharmacy best practices on improving medication adherence to the Global Medi-Cal DUR Board of the California Department of Health Care Services (DHCS).
She shared how she integrated culturally competent care models into her telepharmacy outreach program development to advance health equity, driving improved health outcomes.
Her expertise in cultural competency is further detailed in 9 Proven Strategies for Reducing Health Disparities in Pharmacy Practice, which highlights actionable approaches to addressing health inequities and fostering systemic change.
Medicaid Pharmacists: Leading Population Health & Redefining Pharmacy Leadership
The impact of Medicaid pharmacists on population health is evident in their leadership of initiatives that improve medication adherence. The following strategies illustrate how their efforts enhance patient outcomes and strengthen healthcare systems.
Reducing Healthcare Costs by Improving Medication Adherence
Medicaid Pharmacists help decrease hospitalizations and emergency room visits, generating substantial cost savings for Medicaid programs.¹ ⁴
Given that the U.S. has the highest per capita GDP for healthcare, Medicaid pharmacists—like their non-Medicaid counterparts—help bridge cost gaps by optimizing medication use and reducing preventable health expenditures.
This finding aligns with the Triple Aim framework—enhancing patient experience, improving population health, and lowering healthcare costs—reinforcing Medicaid pharmacists’ role in delivering sustainable, high-quality care.
Advancing Cultural Competency in Pharmacy Practice
Cultural competency is a cornerstone of population health pharmacy, ensuring that medication adherence strategies account for diverse patient needs, beliefs, and social determinants of health.
Medicaid pharmacists integrate culturally tailored interventions into patient care, recognizing how language barriers, historical mistrust, and systemic inequities influence adherence.
Race concordance—patients being treated by healthcare providers of the same racial/ethnic background—has been shown to increase trust and engagement, reinforcing the need for diverse representation within pharmacy leadership.
By embedding cultural competency into Medicaid pharmacy programs, pharmacists strengthen patient relationships, improve adherence, and advance health equity.
Collaborating with Interdisciplinary Care Teams to Improve Medication Adherence
Medication adherence extends beyond pharmacy—it requires a multidisciplinary, team-based approach for sustainable patient outcomes.
Medicaid pharmacists collaborate across disciplines to align patient-centered medication plans with broader healthcare goals.
Partnering with physicians, nurses, case managers, and social workers, they advocate for medication access and treatment optimization, reducing disparities and enhancing outcomes.
Their leadership in clinical interventions ensures adherence remains a priority across healthcare touchpoints.
Case Study: How Medicaid Pharmacists Reduce Costs & Improve Medication Adherence
Medicaid pharmacists transform population health pharmacy principles into reproducible outcomes, reducing costs and improving medication adherence.
The following case study highlights pharmacist-led interventions that successfully improved adherence and strengthened Medicaid program efficiency.
A Medicaid initiative targeting high-risk, non-adherent patients with chronic conditions integrated MTM sessions and community-based partnerships (CBOs), resulting in:
A 15% increase in adherence rates among participants.¹
A 25% reduction in hospital readmissions through improved chronic disease management.¹
Significant cost savings, reinforcing the effectiveness of pharmacist-led interventions.¹
These results underscore the critical role of Medicaid pharmacists in improving medication adherence and advancing sustainable population health pharmacy outcomes.
Strengthening Medication Adherence & Population Health in Value-Based Care
Medicaid pharmacists are more than medication experts—they are population health champions, driving value-based care and shaping the future of healthcare.
This article has demonstrated how Medicaid pharmacists close care gaps, optimize healthcare frameworks, and restore pharmacy’s role in direct patient care.
Their leadership in population health and value-based care marks a shift from the limitations imposed by the 1951 Durham-Humphrey Amendment, reaffirming pharmacists as key healthcare providers.
As pharmacist-driven programs grow, Medicaid pharmacists remain at the forefront of innovation, integrating policy-driven interventions, data-informed strategies, and clinical expertise to transform healthcare delivery and patient outcomes.
Their impact underscores the necessity of expanding pharmacist-led initiatives—particularly within state-based population health models (looking at you, DHCS).
Sustaining their role requires ongoing investment, system-wide support, and collaboration to ensure pharmacist-driven solutions remain at the forefront of equitable and sustainable healthcare.
Topics: Medication Adherence
References
Centers for Disease Control and Prevention. “Medication Therapy Management in Medicaid.” Centers for Disease Control and Prevention website. Updated March 2021. Accessed December 26, 2024. https://www.cdc.gov/cardiovascular-resources/media/MTM_in_Medicaid-508.pdf.
Chan, Mabel, et al. "Pharmacist-Led Deprescribing for Patients With Polypharmacy and Chronic Disease States: A Retrospective Cohort Study." J Pharm Pract. 2023 Oct; 36(5):1192-1200. Accessed February 13, 2025. https://pubmed.ncbi.nlm.nih.gov/35522029/.
Daly, Christopher J., and David M. Jacobs. “Implementing a Social Determinants of Health Program.” University at Buffalo School of Pharmacy and Pharmaceutical Sciences, n.d., Community Pharmacy Foundation. Accessed 31 Jan. 2025.
Moczygemba, Leticia R, et al. “Comprehensive Health Management Pharmacist-Delivered Model: Impact on Healthcare Utilization and Costs.” Am J Manag Care, vol. 25, no. 11, 14 Nov. 2019, www.ajmc.com/view/comprehensive-health-management-pharmacistdelivered-model-impact-on-healthcare-utilization-and-costs?utm_source=chatgpt.com. Accessed 31 Jan. 2025.
Montgomery, E., Sherod-Harris, T., Adkins, M., & Hinely, M. “Impact of Pharmacy Involvement on Care Gap Closure in Managed Medicaid Patients.” Am J of Health-System Pharmacy, Published 21 Nov. 2024, doi:10.1093/ajhp/zxae328. Accessed January 30, 2024. https://pubmed.ncbi.nlm.nih.gov/39570898/.
The American Journal of Managed Care. “Cost Savings From an mHealth Tool for Improving Medication Adherence.” Am J Manag Care. Published September 1, 2023. Accessed December 26, 2024. https://www.ajmc.com/view/cost-savings-from-an-mhealth-tool-for-improving-medication-adherence.
The American Journal of Managed Care. “Reducing Barriers to Medication Access and Adherence for ACA and Medicaid Participants: A Peer-to-Peer Community-Based Approach.” Am J Manag Care. Published April 22, 2022. Accessed December 26, 2024. https://www.ajmc.com/view/reducing-barriers-to-medication-access-and-adherence-for-aca-and-medicaid-participants-a-peer-to-peer-community-based-approach.
Weiser P. “How Pharmacists Can Influence HEDIS Measures and Value-Based Care.” Outcomes™ Blog. September 21, 2022. Accessed December 29, 2024. https://blog.getoutcomes.com/perspectives/how-pharmacists-can-influence-hedis-measures-and-value-based-care.