A health-care delivery approach that rewards providers for keeping patients healthy and improving outcomes instead of charging for each test or visit. For investors, it matters because it shifts where profits and losses come from—favoring providers and technologies that lower long-term costs, prevent complications, and demonstrate measurable results; think of it like paying a contractor only when the house stays sound, which changes who wins and loses financially.
ncqa hedismedical
NCQA HEDIS is a standardized set of measures produced by the National Committee for Quality Assurance that evaluates the quality and performance of health plans and providers on routine care, preventive services, and disease management. For investors, HEDIS scores act like a report card: higher scores signal better care delivery, stronger member retention and lower risk of regulatory or payment penalties, which can influence a health plan’s reputation, revenues and valuation.
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"Point-of-care" refers to the location where immediate decision-making or actions happen, often involving the direct delivery of services or results. In healthcare, it describes tests or treatments performed directly at the patient's side, rather than in a distant laboratory. For investors, understanding "point-of-care" highlights the convenience, speed, and potential growth opportunities of services or products that bring solutions directly to the user or patient.
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A1C is a blood test that reports average blood sugar over about three months by measuring how much glucose sticks to hemoglobin, a protein in red blood cells. For investors, A1C acts like a long-term scorecard for diabetes treatments, devices and diagnostics: meaningful changes in A1C in clinical studies can affect regulatory approval, insurance coverage and commercial prospects, and thus influence a company's market value.
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Community pharmacists incentivized to help close care gaps for members with hypertension and diabetes
LOUISVILLE, Ky.--(BUSINESS WIRE)--
Humana Healthy Horizons in Ohio and CPESN®USA are expanding access to care throughout Ohio with the launch of its first Pharmacist Quality Rewards program, a value-based care (VBC) initiative designed to improve outcomes for members living with chronic conditions. The program builds on Humana’s existing partnership with CPESN® pharmacies by financially incentivizing community pharmacists to help close care gaps for members diagnosed with hypertension and diabetes.
“Community pharmacists are uniquely positioned to support members with chronic conditions because they see them consistently and are deeply embedded in their communities,” said Kathie Mancini, President, Humana Healthy Horizons in Ohio. “This value-based program recognizes the critical role pharmacists play in improving health outcomes while expanding access to convenient, high-quality care.”
A Value-Based Approach to Chronic Condition Management
Humana collaborated closely with CPESN®USA and internal clinical, pharmacy, and population health partners to design a market-specific pay-for-performance model aligned to Humana’s Chronic Conditions Population Health Stream. The program focuses on members managing hypertension or diabetes—conditions often treated with long-term medication therapy and frequent pharmacy visits.
Most members visit their community pharmacy every month, which means they will likely interact with their pharmacists more often than they do with their primary care provider. Through this program, CPESN® pharmacies receive actionable insights to help identify members with gaps in care and engage them at the point of care.
Participating CPESN® pharmacists receive a list of members who fill prescriptions at their pharmacy and may be missing recommended screenings or have out-of-range results. Pharmacists then encourage members to complete appropriate testing—often on-site through point-of-care services—and notify prescribers when results indicate additional follow-up is needed.
Performance Measures Aligned to Quality Outcomes
The Pharmacist Quality Rewards program financially rewards CPESN® pharmacies for meeting NCQA HEDIS National Medicaid Percentiles including:
Controlling High Blood Pressure (CBP)
Glycemic Status Assessment for Patients with Diabetes (GSD) – A1c <8%
Blood Pressure Control for Patients with Diabetes (BPD)
Early results from CPESN® pharmacies in Ohio demonstrate the impact of engaging trusted community pharmacists in value-based care.
At Medicine Center Pharmacy, a CPESN®Ohio pharmacy in New Philadelphia, Ohio, pharmacists identified several Humana Healthy Horizons members with hypertension who were overdue for blood pressure testing during routine prescription pick-ups. By offering same-day point-of-care testing and counseling, the pharmacy helped reconnect members to critical monitoring—alerting prescribers when results were out of range and encouraging follow-up care.
“For many of our patients, the pharmacy is the most accessible part of the health care system,” saidclinical lead Angela Rademacher, PharmD. “By meeting patients where they already are, we can identify gaps in care, have real conversations about their health, and work directly with prescribers to support better outcomes.”
Expanding Access Through Community-Based Partnerships
“Our mission at CPESN®USA is to bring payers, pharmacies, and communities together around locally delivered, value-driven care,” said Troy Trygstad, PharmD, MBA, PhD, Executive Director of CPESN®USA. “This program demonstrates how community-based pharmacies can meaningfully contribute to quality improvement and better outcomes for people living with chronic disease.”
By recognizing and rewarding pharmacists for their role in chronic condition management, Humana aims to help members live well with their conditions, reduce barriers to care, and strengthen coordination between pharmacists and prescribers.
This initiative reflects Humana’s broader commitment to value-based care models that improve health outcomes, enhance the member experience, and support community-based providers as essential partners in care delivery.
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. Learn more about what we offer at Humana.com and at CenterWell.com.
