There is no question that patients, providers, payers and even pharmaceutical manufacturers saw a world of change when Affordable Care Act (ACA) was signed into law. While health exchanges add complexity to the business of healthcare stakeholders, some of the changes have been beneficial to patient populations and to the delivery of healthcare services. Reimbursement based on value, rather than volume, supported by robust technology advancements, drives many process changes throughout the healthcare industry.
An expanding role for pharmacists
Hospitals, medical practices and individual providers have been heavily involved in creating new standards of care, clinical pathways and health-information solutions to deliver safe, high-quality and cost-effective care, and to analyze outcomes. Payers, who are ensuring more individuals than ever before, promote efficiencies, quantify quality outcomes and align reimbursements. Although their post-ACA evolution may not be as visible as with providers and payers, pharmacists also experience change.
In many parts of the country, pharmacists are no longer fill-and-bill distribution points for pharmaceuticals. Rather, many states legislate an expanded role for pharmacists within the healthcare continuum of care.
Anne Burns, vice president for professional affairs for the American Pharmacists Association, addressed this expanded provider status and the related opportunities during an educational session at last year’s Good Neighbor Pharmacy’s ThoughtSpot. Burns sees legislation that will recognize pharmacists as providers under Medicare Part B, which is working its way through the U.S. House of Representatives and the U.S. Senate, as an opportunity for pharmacists to practice at the top of their license. In addition to their traditional role in dispensing prescription pharmaceuticals, the federal legislation would allow them to perform chronic disease management roles, especially in medically underserved areas. In many states, pharmacists already have an expanded role by providing vaccinations without prescriptions.
With the U.S. Department of Health and Human Services emphasizing a pay-for-performance model, rather than the traditional fee-for-service, pharmacists see the same foundational change of quality over quantity that providers experience. This is a substantial change for pharmacists, but it offers a great opportunity for community pharmacies to be integrated, collaborative partners in the delivery of healthcare. This also positions pharmacists as a key stakeholder that pharmaceutical manufacturers need to influence in order to improve awareness, education and fulfillment of prescriptions for their products.
A solution to a strained healthcare system
According to the Partnership to Fight Chronic Disease, chronic disease accounts for 75 percent of healthcare spending. And, the New England Healthcare Institute estimates that the cost of medication nonadherence is about $300 billion. Community pharmacists are uniquely positioned to support patient care and to help reduce the incredible cost associated with chronic disease and medication nonadherence. With the appropriate technology infrastructure, providers and pharmacists could work in tandem to manage a patient’s chronic disease and ensure medication adherence.
“The evidence tells us that there’s an undeniable positive impact on patient health by being medication adherent,” says Tony Willoughby, formerly vice president and chief pharmacist at Health Mart, an affiliate of McKesson Connected Care & Analytics. “If a retail pharmacy can help a hospital keep its patients adherent, it can reduce emergency room visits, admissions, readmissions and lengths of stay — all of which drive up the total cost of care.”
From a pharmacy’s perspective, this kind of integration and partnership not only supports quality population health, it also offers a financial benefit.
“Such relationships provide an opportunity to generate new customers and return visits,” says Jonathan Niloff, M.D., vice president and chief medical officer at McKesson. “If the partnership includes the formation of a narrow or preferred provider network in which the pharmacy is included, the pharmacy may benefit from increased revenue that results from seeing more patients and filling more prescriptions.”
Community pharmacists are trusted neighbors. A patient may enter the pharmacy for a prescription, but end up talking with his or her community pharmacist about additional topics, such as medication adherence, lifestyle changes, direct-to-consumer advertising about certain drug therapies, and routine and travel vaccinations.
With determination and good will, pharmacy and health system partnerships can jointly respond to the imperative to maximize medication adherence and effectively manage patients with chronic disease. At its core, this type of partnership requires:
- Aligned goals and incentives
- Coordinated work flow
- Optimal communication
- Shared, communal access to health information technology, data and analytics
- Respect for each partner’s perspective
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