Transforming Community Pharmacists Into Care Providers

Kevin Boesen, PharmD, chief commercial officer at Outcomes, delivered a session at the Total Pharmacy Solutions Summit focused on transforming community pharmacists into the nation’s core primary care providers. Boesen detailed how impending policy shifts in Medicare and rapid advancements in automation are creating a massive opportunity for both revenue growth and clinical impact. He argued that with a persistent physician shortage, the community pharmacist is the best-positioned resource to manage the chronic illnesses that drive the majority of US health care costs.

Boesen explained that the Centers for Medicare & Medicaid Services (CMS) altered qualification criteria, effectively doubling the number of patients eligible for the benefit. Although the comprehensive medication review (CMR) completion rate is temporarily categorized as a display measure for 2025 and 2026, it is set to return as a “star measure” in 2027.

To handle this increase in volume, Boesen emphasized that pharmacies must move away from manual data entry and administrative burdens. Outcomes is addressing this through medication therapy management (MTM) intelligence, which utilizes artificial intelligence (AI) to infer patient conditions and prepopulate action plans for pharmacists, streamlining the reconciliation process. Furthermore, Boesen highlighted new workflow innovations, such as automated e-prescription processing and high-resolution pill-counting devices.

Addressing a common concern that MTM can feel like a checkbox task in a busy workflow, Boesen urged a shift in professional mindset. He characterized the CMR as a “critical lifesaving event” that allows pharmacists to coordinate therapy for patients with complex, uncoordinated care. To support this, Outcomes is integrating AI-driven quality checks to ensure clinical recommendations are consistent and thorough, helping justify the value of these services to the payers who fund them. Boesen also pointed to emerging medically billed opportunities in states such as Pennsylvania and Maryland as a sign that pharmacists are increasingly being recognized—and reimbursed—as health care providers.

Key Takeaways From the Presentation

• Policy changes are expected to increase CMR opportunities 4-fold by 2027, creating a significant revenue stream for community pharmacies.
• Pharmacists are uniquely suited to manage chronic diseases like diabetes and hypertension, which represent the bulk of health care spending.
• New links between dispensing systems and clinical platforms allow pharmacists to identify and bill for clinical opportunities without leaving their primary workflow.
• AI is being used not only for efficiency but also to score patient complexity and ensure clinical quality across a network of 40,000 pharmacies.

Boesen concluded by acknowledging the difficult business models many pharmacies face but remained optimistic about the future of the profession. By leveraging technology to reclaim time and focusing on high-impact clinical interventions, he believes, the community pharmacist will officially become a primary care provider much sooner than many expect. The goal is a unified experience in which dispensing and clinical services are seamlessly integrated, empowering pharmacists to improve patient outcomes and thrive as local health care leaders.