Pharmacists Cut Costs and Improve Care for High-Utilization Patients | Asembia AXS26

Samir Malkani, MD, clinical chief in the division of diabetes, endocrinology, and metabolism at UMass Memorial Health, explores how pharmacists play a critical role in managing high-utilization patients, particularly those with chronic conditions like diabetes who frequently visit the emergency room (ER), experience long hospital stays, and generate high total medical expenditures. Malkani explains that these patients often struggle with medication adherence due to personal beliefs, financial barriers, polypharmacy, and complex regimens.

Pharmacists can significantly improve outcomes by simplifying and supporting medication use. Strategies include enrolling patients in patient assistance programs or free care programs, switching to cheaper generic alternatives, combining therapies when clinically appropriate, and using pill packs to make complex regimens easier to follow. These interventions directly support value-based care by targeting the most important ACO metric: total medical expenditure, as well as reducing hospital admissions, ER visits, and days in the hospital. Achieving key Healthcare Effectiveness Data and Information Set measures—such as regular hemoglobin A_1C checks, urine microalbumin tests, lipid profiles, and appropriate medication use—further demonstrate the value of pharmacist-led care.

Malkani also highlights the operational challenges pharmacists face in high-volume dispensing environments. To allow pharmacists to work at the top of their license, he recommends leveraging pharmacy technicians for dispensing tasks and carving out dedicated counseling times during slower periods. Another key solution is to have pharmacists dedicated specifically to care coaching roles, where they can focus on analyzing social determinants of health and connecting patients with financial, housing, and mental health resources.

By building trusting relationships and addressing both clinical and social needs, dedicated pharmacist care coaches have demonstrated reductions in total medical expenditure, fewer hospital admissions, and lower ER utilization among high-risk, high-need patients.

“It is very important for the pharmacist to gain the patient's trust and so that the patient doesn't feel shamed,” Malkani said. “The pharmacist has to engage with the patient. They have to be familiar with resources that they can have for the patient and then counsel them on the resources [and] pair them up with the appropriate agencies.”