Medication adherence counseling is something pharmacists do best. Evolving paradigms in healthcare delivery will resolve how they will be paid for it.
Tripp LoganTo busy pharmacists, the idea of spending time and money on helping patients with medication adherence may sound like a fantasy. However, boosting adherence rates is just the ticket for community pharmacies, and not just because it’s good for patients, two pharmacists told attendees at the recent annual meeting of the American Pharmacists Association in San Diego. For-profit pharmacies gain, they said, through making more money, as the medical system invests in them in its bid to improve patient health and reduce costs overall.
The adherence problem is widespread, said Tripp Logan, PharmD, a pharmacist at L&S Pharmacy in Charleston, Mo. “People typically don’t understand their medication regimens and why they’re taking medicine,” said Logan, who pointed to statistics suggesting that 12% to 23% of prescriptions are never even filled.
The good news, he said, is that the return on investment in medication adherence is staggering. “For every dollar we spend on medication adherence in diabetes, the healthcare system saves $7,” he said. That’s a 7:1 savings ratio, and the savings for hypertension and cholesterol (4:1 and 5:1, respectively) aren’t far behind.
The Congressional Budget Office has estimated that each 1% increase in prescription fills will translate to a decrease of 0.20% in expenditures for medical services, he said.
Joe Moose“Community pharmacy is perfectly positioned to help solve [the medication adherence] problem through investment in us,” Logan said. “Not only do we make people better, but we can solve a lot of healthcare-system problems too. ”
More investment in pharmacy translates to more income for pharmacies. But how can pharmacists increase medication adherence when they’re already often swamped?
It’s important to get out of the mindset that boosting adherence means providing care management to every patient or every patient who has diabetes, said Joe Moose, PharmD, who helps oversee five Moose Pharmacy locations in North Carolina and manages the one in Concord, N.C.
Instead, “We need to look at the sickest of the sick to get the most return on investment for whoever the payer is,” he said.
See also: 21 ways to boost medication adherence
“The average chronic patient will see 13 different providers in a year’s time. The legacy system leaves it in the patient’s hands to coordinate those 13 providers,” Moose said.
Pharmacists can play a key role in filling gaps in coordination. To do this, he said, it’s crucial to analyze data and triage patients so that those who need the most help receive it. Software can assist by pinpointing patients who need assistance, such as those who are having trouble controlling their hemoglobin A1c levels.
The Moose Pharmacy locations have developed report cards that reveal the difference that attention to medication adherence can make for individual patients. “The easiest patients to work with are the sickest of the sick, because you can make the most impact,” Moose said.
Another strategy is to offer transition-of-care services. When contracted for this service, the pharmacy gets in touch with a patient within 72 hours.
“The quicker we can get to this patient in these 72 hours, the quicker we’re finding problems,” he said. “These aren’t patients we’re necessarily filling prescriptions for. We may be calling Drugstore X and asking which prescriptions they have for this patient.”
In the big picture, said Moose, “what payers care about is money - increasing quality, decreasing cost.” Pharmacists, he said, can accomplish both.
“The reason we have to change [our focus] is because we can’t afford to keep doing things the way we’ve been doing them,” Moose said. “Some will say: ‘That’s all well and good, but we fill 1,000 prescriptions a day.’ I’m saying that you’re going to have to change, since we can’t afford not to.”
Logan put it this way: “We need to look to ourselves as part of the solution instead of another part of the problem.”
Randy Dotinga is a medical writer based in San Diego, Calif.