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CARRIER FAQ’s

Q: What is a “Patient Self Management” program?

A: In 2003, the Institute of Medicine defined self-management support as “the systematic provision of education and supportive interventions by health care staff to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support.” Simply stated, a "Patient Self Management Program" provides you with education so that patients become a more active part of their health care team. When patients become more involved in their health care, the result is that patients will be healthier and more compliant!

Q: What qualifies a pharmacist to coach patients?

A: Today, all graduating pharmacists receive their Doctor of Pharmacy degrees from an accredited institution, which constitutes approximately six years of schooling. Many pharmacy graduates opt to complete a one- to two-year residency program, and some continue on to complete a fellowship in a specialized area of practice. As a result, pharmacists receive six to ten years of education.

In addition to college, residencies and fellowships, many pharmacists complete certificate programs that focus on a specific chronic condition. LPIHO requires that any pharmacist participating in the program complete a certificate program for the chronic disease module(s) in which they wish to participate as a coach.

Q: If one of my clients decides to enroll into one or both of the programs offered by LPIHO, what are the carrier’s responsibilities?

A: The carriers are responsible for the following:

  • Providing a ZIP code analysis for the patient population for whichever disease state(s) is being implemented. This allows LPIHO know where pharmacist coaches will be needed.

  • If reduced or waived copays is the incentive the employer chooses to offer, the carrier will need to discuss with the LPIHO Care Team how this process will work

  • Carriers will need to provide baseline data (12 months prior to start of program) as well as annual data thereafter (once every 12 months) in format agreed upon by all local carriers

Q: How will I know when a ZIP code analysis is needed?

A: Your client (employer group) will request this directly from the carrier

Q: How will we know when reports need to be run?

A: Your client (employer group) will make a formal, written request to both medical and prescription claims, along with signed consent from each participant to release their data. All forms required to release such data have been reviewed and approved by the major carriers in Lancaster County.

Do you have questions or concerns that were not addressed here?

If so, please contact a member of LPIHO’s Care Team


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