The pharmacist’s role is expanding as the healthcare arena moves from fee-for-service to value-based payments.
“Physicians are warming to the idea of working alongside pharmacists in their practice settings. In fact, not only are they warming to it, many physicians are carving out a pharmaceutical piece of part of their risk-sharing agreements,” says Susan Cantrell, RPh, CEO of the Academy of Managed Care Pharmacy (AMCP).
Medicare accountable care organizations (ACOS) do not directly include pharmacists and medications, but appropriate medication management is necessary to ensure success of value-based arrangement, Cantrell explains. “Therefore, we are seeing a trend where physicians are trying to integrate pharmacists and medication management to achieve good outcomes,” she says.
Medication therapy management (MTM) is one of the biggest areas in which physicians increasingly rely on pharmacists, says Lucinda Maine, PhD, RPh, executive vice president and CEO of the American Association of Colleges of Pharmacy (AACP). “As physicians need to meet expectations around quality-based metrics, they are finding they can move those quality needles when a pharmacist provides MTM.”
In some cases, pharmacists embedded in practices or hospital pharmacists are meeting with patients prior to physician visits and conducting thorough medication reviews and assessments. “This relieves the physician of doing that part of the care plan,” she says. “Once physicians sees the value of the pharmacist, they don’t want to practice any other way.”
Community pharmacists are also experiencing role changes, as they too are providing medication management across the continuum of care. Some community pharmacists are partnering with nearby hospitals to more thoroughly counsel patients regarding medication and adherence. The expanding role of pharmacy technicians and robotics should also liberate these pharmacists to take on more of these tasks, says Maine.
Here's more on how the role of pharmacists is changing in various practice settings.
Community pharmacy is the biggest area in which pharmacists can be better used because they have such frequent interactions with patients, says Marilyn Stebbins, PharmD, vice chair for clinical innovation, University of Southern California San Francisco (UCSF) School of Pharmacy. “Most people visit a retail pharmacy more than 20 times a year; this is where the pharmacist’s impact is the greatest,” she says.
Pharmacists are offering vaccinations, blood pressure screenings, and counseling on specific disease states such as diabetes. “In the retail setting, MTM, and not dispensing, should be the priority,” says Stebbins. “In this way, pharmacists can help improve outcomes and show their value.”
Community pharmacists are also experiencing a growing role as hospitals look to them as a resource to improve adherence and reduce readmissions, a key metric in many value-based payment arrangements. One example is the “Meds to Beds” program at UCSF. Pharmacists from two retail pharmacies on the hospital campus meet with patients before they leave the hospital. The pharmacists explain their discharge medications and then follow up with patients to ensure they are compliant. The program has had good results, says Stebbins.
1. National Committee for Quality Assurance. Overview of PCMH. Available at http://www.ncqa.org/programs/recognition/practices/patient-centered-medi.... Accessed April 19, 2018.
2. University of North Carolina Eshelman School of Pharmacy. Achieving Better Quality and Lower Costs in Medicaid through Enhanced Pharmacy Services. Center for Medicaid Optimization through Practice and Policy. Available at https://pharmacy.unc.edu/files/2015/03/Achieving-Quality-and-Lowering-Co... Accessed April 20, 2018.