Pharmacists can join a practice, provide services to multiple practices, or join a larger provider organization. Leal began creating pharmacist patient-care programs with a local health center, El Rio, before joining SinfoniaRx.
“Health centers are great partners,” she said. “They are always looking for new ideas to better serve their patient populations in very targeted ways. Whatever the setting, you can provide a realistic business model for providers that improves care and outcomes, and integrates clinically with what they are already doing.”
Most pharmacists moving into patient care are embedding themselves into an existing primary care or specialty medical practice, said Anne Burns, senior vice president for professional affairs at the American Pharmacists Association. Practices have the Part B providers and CMS billing expertise, while pharmacists have the medication expertise.
Projects and programs
Other pharmacists are joining demonstration projects funded by the Center for Medicare and Medication Innovation or state programs.
• In Hawaii, a hospital pharmacist-community pharmacist program, Pharm2Pharm, is improving transitional care management for older residents in three rural counties.
• The University of Southern California is integrating pharmacists into the front line in safety-net clinics in order to improve adherence and confirm the appropriateness and safety of medication use, with the goal of reducing avoidable hospitalizations or ER visits.
• Virginia is using pharmacists to improve health for at-risk patients in 23 rural counties. A collaborative practice model gives pharmacists access to electronic medical records to coordinate care and improve outcomes for patients with multiple chronic diseases.
• In Wisconsin, pharmacists are working with prescribers to reboot prescription drug therapies using evidence-based standards of care for diabetes, chronic heart failure, asthma, and geriatric syndromes. That comes on top of the Wisconsin Pharmacy Quality Collaborative, funded by Medicaid and private payers, which brings pharmacists into comprehensive medication reviews by appointment with patients.
The MTM continuum
Medication review is familiar ground for McDonough. With nearly 20 years of practice, he has developed a system of continuous MTM, plus a software package, PharmClin, to document the results. And he is doing it as part of the dispensing process.
“MTM isn’t an event, it is a continuum,” he said. “We call it continuous medication monitoring. We review each and every patient who comes into our pharmacy, every time they come in. So instead of waiting to do a comprehensive medication review, we have an ongoing story for every patient.”
His two pharmacies are documenting more than 2,000 interventions every month, McDonough continued. Trained pharmacists can assess a patient in three to five minutes, he said, fast enough that the patient doesn’t notice and with enough detail that major payers are paying for the quality difference.
“In a pay-for-performance world, you don’t just have to improve care, you have to document it and talk about it,” he said. “Payers are looking for providers who can improve patient outcomes. Show them the evidence and they will respond.”