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The nation's governors get it and have affirmed it publicly. When will the rest of the country get on board?
Ned MilenkovichIn January 2015, the National Governors Association (NGA) released a white paper titled “The Expanding Role of Pharmacists in a Transformed Health Care System.” The paper challenges states to change their laws to allow pharmacists, who represent the third-largest healthcare profession, to become more integrated into the healthcare delivery system. The NGA, along with healthcare experts, acknowledges the essential role that medication management plays in treating chronic diseases, and it stresses that including pharmacists in chronic-care delivery teams will both improve health outcomes and reduce costs.
The pharmacist’s role
The healthcare system is experiencing a fundamental shift in the areas of finance and delivery of healthcare services. States are formulating laws, regulations, and best practices to improve outcomes while reducing costs.
Factors underlying this trend include a growing number of adults who have chronic diseases, such as heart disease, stroke, cancer, arthritis, hepatitis, and asthma. With over 117 million U.S. adults suffering from at least one chronic disease, the number of people taking multiple medications is also very high. And as the number of medications increases, so does the rate of nonadherence to the proper medication regimen, the consequences of which are both physical and monetary in nature.
Pharmacists have the capabilities to play a large role in shaping healthcare delivery to individuals, especially to those with chronic diseases. Pharmacists’ expertise includes medication therapy management, wellness counseling, disease-prevention services, and primary care. These services are most effective when the pharmacist is included in the larger interdisciplinary team, which can be documented through collaborative practice agreements (CPAs).
CPA agreements streamline patient care and allow licensed providers to refer patients to a pharmacist for corresponding healthcare services. This integration also allows for a patient’s entire healthcare team to collaborate and maintain transparency, increasing the quality of both individual healthcare services and the entire patient healthcare plan.
Several barriers currently distance pharmacists from full integration into the healthcare delivery system and prevent them from providing direct patient-care services. The most significant barriers include restrictive laws and regulations governing CPAs, the lack of appropriate compensation or reimbursement of pharmacists for direct patient-care services, and limitations on their access to health IT systems.
Administrative barriers. Many states do allow pharmacists to participate in a collaborative healthcare delivery system; however, the administrative barriers in many of these states deter pharmacists from acting in this capacity.
For example, some states require separate CPAs for each patient, which stifles the efficiency of the process. Creating laws and regulations that reflect the healthcare system’s shift in priorities will help encourage pharmacists to become part of these interdisciplinary teams, a development that would only increase the effectiveness, efficiency, and quality of healthcare services.
Third-party recognition. Collaborative integration of pharmacists will also require recognition by third-party payers, if the cost structure is to reflect the needs of both patients and healthcare providers. For example, although many strides have been made in connection with reimbursements for pharmacists’ cognitive interventions, many states and private healthcare plans still set limits on pharmacists who wish to bill directly for their services. This acts as a deterrent for both pharmacists and patients.
Access to health IT. Finally, access to health IT systems is essential if pharmacists are to take their place on the collaborative healthcare team.
In order to provide the highest level of care, pharmacists need to monitor the patient’s adherence to drug regimens, identify drug interactions, and modify medications. Creating a platform that gives all providers access to patient information on a uniform health IT system will directly increase the quality of patient care. One of the largest obstacles to creation of this transparency lies with state laws and their failure to recognize pharmacists as providers.
As our healthcare system continues to take steps to increase the quality of services and lower costs associated with healthcare, it is important to acknowledge the value that pharmacists can add and to adopt laws, regulations, and policies that allow and encourage interdisciplinary healthcare teams.