Perspectives that Matter

Palmetto Primary Care Physicians Unlocks Medication Adherence Performance in Six Months with Stellus Rx



Dr. Paul Fleming
Director of Quality
Improvement, PPCP

Dr. Ashton Glasgow
Clinical Pharmacist, Medication Prior Authorization Manager, PPCP
Dr. David Castellone
Physician and
Cofounder, PPCP





Working in partnership with Stellus Rx, South Carolina-based Palmetto Primary Care Physicians (PPCP) went from “year after year” of 2- and 3-star performance in HEDIS medication adherence measures to 4- and 5-stars in 90% of medication adherence measures within the first six months of work together.

As Dr. Paul Fleming, Director of Quality Improvement for PPCP, describes: “As pharmacists, we realize that medication adherence is not just about stars scores and shared savings … but high stars scores do mean that patients are controlling chronic conditions better, staying out of the ED and hospital and experiencing a better quality of life.

Stellus Rx has been a phenomenal partner. We are already having meetings to discuss our strategy for increasing that number to 100%. We are confident that Stellus Rx will help get us there.”

In this interview with PPCP Clinical Pharmacy Specialists Dr. Fleming and Dr. Ashton Glasgow, as well as PPCP Physician and Cofounder Dr. David Castellone, we share a behind-the-scenes look into PPCP’s partnership with Stellus Rx to support medication adherence. We explore how PPCP and Stellus Rx orchestrated this turnaround in medication adherence performance, what the experience of working together has looked and felt like for PPCP and its staff and how all that aligns to PPCP’s broader vision for care in the communities it serves.


Let’s start with a bit about your practice. What should people know about Palmetto Primary Care Physicians (PPCP)?

Dr. Paul Fleming: If you look at PPCP from the outside today, you’d see we’re a large physician group: 40 offices, more than 125 providers spanning eight counties across South Carolina. But if you dig a little deeper into our roots, you’d see that we truly pride ourselves on being an innovative organization, not just a large one.

Since our founding in 1997 by seven local physicians—including Dr. Castellone—we’ve grown from the original three primary care practices to become the largest independently owned physician group in our state. We were among the first physician groups in the country to adopt a fully integrated electronic health record, in 1999. Our group was the first in the state to launch a patient-centered medical home (PCMH) program, and we formed an accountable care organization for patients with traditional Medicare to optimize patient outcomes/control costs.

Our care coordination team—which includes pharmacists, social workers, and registered dietitians—has provided free patient education classes and one-on-one patient consults for nearly 10 years. Regardless of age or health condition, we want all our patients to feel empowered to take control of their own health.


What initiatives has your practice undertaken to perform in new, value-based care structures? Beyond your work with Stellus Rx to drive performance in medication adherence, can you describe what your practice has done to deliver care with an eye toward value over volume?

Dr. Paul Fleming: It starts with access, and we have tried our best to remove the barriers that stand between patients and getting the care they need. So that means implementing telehealth visits, where patients can remain in their homes, where they are most comfortable … but also in-car visits, where we’ll actually meet patients in the parking lot, when mobility might otherwise be a challenge.

We’ve beefed up our patient outreach team to get patients scheduled for visits, with an emphasis on getting Medicare patients in for their annual wellness visits. As a free benefit to patients with Medicare, this visit allows us to cover a lot of ground with patients that they might not be able to cover during a typical follow-up visit, and we have designed note templates that help us meet at least 10 different quality measures during that visit.

In between visits, our care coordination team offers free education classes to patients to help them prevent and control diabetes, stop smoking and eat healthier to empower them in the management of chronic conditions. We also partner with a company that provides mock patient experience surveys to our patients to help our providers drill down and determine how we can improve care quality and the care experience for patients.


What are the challenges you’ve seen in trying to create balance between intense focus on patients, balance and quality of life for providers and staff members … all while keeping an eye on external performance metrics?

Dr. Ashton Glasgow: The documentation burden on providers is a huge challenge. Providers balance providing high-quality patient care with the administrative burden of clicking boxes to satisfy MIPS measures along with writing notes that justify every diagnosis code that they enter into the chart note, assessing “suspect” conditions that the patient might have and justifying E&M codes. It is a huge challenge for our providers. We have created order sets, templates and quick notes to help, as well as encouraged providers to use scribes and voice recognition software.

Even though all of these are helpful, there is still a tremendous amount of work required to dot all “i”s and cross all “t”s. Unlike many physician practices, Palmetto Primary Care Physicians has a quality and care coordination team that takes the burden of monitoring external performance metrics from our providers for the most part. That said, as we grow and attract more patients, we simply run out of time and bandwidth to give enough focus to all the measures. For example, we currently employ three pharmacists, but given the broad scope of our daily activities and responsibilities, we are not able to devote the time to medication adherence measures required to move the needle.


That seems like a natural point for us to turn focus to your work with Stellus Rx. Can you talk a bit about how the pharmacist-led support from Stellus Rx has provided relief to your team or accelerated performance?

Dr. Paul Fleming: Sure, of course. Despite having three pharmacists on staff, PPCP has always struggled with medication adherence measures. That’s not at all a knock on our staff pharmacists. With our involvement in many organizational initiatives, patient care and education responsibilities, as well as “other duties as assigned,” our team simply could not devote the time needed to manage hundreds of patients from multiple insurance plan contracts to move the needle on HEDIS medication adherence star scores. That literally would have been our full-time jobs.

Another major challenge was that the data we received from health plans was delayed and often outdated. Even when we attempted to work the payer lists, we found that either the patient had already picked up the medication by the time we called them … or the patient had already failed the measure.

It was very frustrating for us and was in some ways, a waste of valuable time. We turned our focus toward measures where we could move the needle, such as colorectal and breast cancer screenings, but as a result, the medication adherence HEDIS stars scores drop to 2- and 3-stars, year after year.

As pharmacists, this was disheartening on a number of levels, because we realize that medication adherence is not just about stars scores and shared savings … but high stars scores do mean that patients are controlling chronic conditions better, staying out of the ED and hospital and experiencing a better quality of life.

I will admit that my team and I were extremely skeptical of claims being made when we first met the Stellus Rx team. Four- and 5-star scores? How? Investing in quality, well-trained clinical staff and excellent analytics is how. Stellus Rx has been a phenomenal partner and I have not heard one negative opinion in the organization about the services they provide. Onboarding was smooth and the Stellus Rx staff we have worked with are friendly, hardworking and knowledgeable.

As an example, they worked with us to create workflows that accommodated PPCP providers and staff, doing so in ways that created the least amount of work on the part of our providers. My team and I have frequent meetings to tweak workflows, discuss metrics and strategize to ensure success. In the end, Stellus Rx delivered the results that were promised during initial marketing meetings, which is rare in this space.

Despite only being onboarded in July 2023 and having to ingest and analyze patient data from three health plans, the fact that Stellus Rx has access to real-time patient data makes their jobs easier and allows timely interventions to be made well before our patients are at risk of failing the measures. We anticipate ending 2023 with 4- and 5-star scores in 90% of our medication adherence measures and are already having meetings to discuss our 2024 strategy for increasing that number to 100%. We are confident that Stellus Rx will help get us there.


Has anything surprised you about the medication adherence work with
Stellus Rx?

Dr. Paul Fleming: What surprises me most is the fact that Stellus Rx invests in clinical staff—pharmacists and pharmacy technicians. These are not inexpensive employees; they are the right employees with the right knowledge and experience to produce the outcomes that will satisfy clients and create mutual success. Many other companies in the healthcare space try to lower overhead costs by hiring employees who have had no healthcare experience.

You can’t build trust with patients that way, even if the employees are using scripts written by clinical staff members. That model just does not work—or at least, it does not work well. It leads to patient and client dissatisfaction, and I know that from previous personal experience!


Before we close out, we’d appreciate the chance to hear from Dr. Castellone and his experience as an end-user and beneficiary of Stellus Rx’s adherence solution. Being one of the busiest providers at PPCP, how did you find Stellus Rx’s approach? Was there any significant interruption to your workflow?

Dr. David Castellone: Not at all, and the messages were very transparent. Messages were sent through telephone encounters in our EMR, which is how I typically receive messages throughout the day. As this fit into my normal workflow, I was able to quickly read the message and forward it to one of my staff members to handle. Overall, I found Stellus Rx’s pharmacists very professional and concise in their communications, and messages that I did receive were very helpful.


How would you characterize the recommendations made by the Stellus Rx pharmacists? Did the communication save you time having to research topics or choose an alternative medication?

Dr. David Castellone: The recommendations were excellent, and I almost felt as if the Stellus Rx pharmacists were working in my office as a part of my team. All the recommendations were very appropriate and gave me a better handle on what was going on with my patients, as far as adherence to their medication regimens. Getting recommendations from the Stellus Rx team and being able to act on those recommendations in a timely fashion helps me provide a better overall quality of care to my patients.


Closing out with you. Paul. What do you think success like this and results like we’ve seen in our work together might tell us about the future of value-based care … or our country’s healthcare in general?

Dr. Paul Fleming: I think that healthcare organizations, including PPCP, are very protective of their patients, and understandably so. Our goal is to provide our patients with the highest quality, most cost-effective care possible, and we are often reluctant to hand over any degree of management to outside entities, thinking that we should be able to do it ourselves.

The positive experience that we have had with Stellus Rx helps eliminate that barrier, and it has shown us that sometimes, we need to reach out for help if we want to meet our goals. Even though the service costs money, it saves us time and effort, prevents the need for additional FTEs to do work that needs to be done, increases the quality of our patient care and increases provider and patient satisfaction. It simply pays off.


Patients’ needs have shifted considerably over the course of the past 4-5 years. Here, Dr. Ashton Glasgow shares her thoughts on some key learnings that came out of COVID and how PPCP continues to learn and adapt to serve the needs of patients.

Dr. Ashton Glasgow: One element that the pandemic reinforced for us was the role that providers play in guiding patients’ decisions about their health. Patients trust their physicians for accurate information and answers, but COVID revealed that many patients—and especially those living in rural areas—need an alternative to routine in-office visits to ensure that their healthcare needs are met.

So, in many ways, the pandemic gave clarity to some of the inadequacies in our organization’s processes and helped us identify opportunities to help improve access to care for our patients, as well as workflows within PPCP.

For example, PPCP was quick to implement telehealth services early in the pandemic. Patients were able to access high-quality care that addressed their acute needs, such as seeking testing or treatment options for COVID symptoms, while also continuing to receive support for chronic conditions. We centralized COVID PCR-based testing and moved all our patient education to a virtual format. All this to say that as we’re constantly adapting the way we work with our patients’ needs and their best outcomes at the forefront of our minds.

We also learned that we wrongly stereotyped our senior patients as tech-challenged individuals who would be overwhelmed by telehealth visits or virtual education classes. These patients have embraced technology, including our recent implementation of an electronic pre-visit check-in platform that allows patients to complete annual paperwork, update insurance cards and other tasks via their smart phones prior to their arrival at the office. I definitely feel that we have underestimated our patients at times … and credit to our organization for continuing to challenge those stereotypes and learn from that.


Published: April 17, 2024