actions to expand pharmacist-provided care

Community Pharmacists

Community pharmacists can consider taking five actions to advance pharmacist-provided care through standardizing services and supporting education, advocacy and marketing. The perspectives of the pharmacists and payers participating in an industry survey and multi-stakeholder roundtable has been summarized in these recommendations.

1. Implement a pharmacy operating model focused on pharmacist-provided care.

Pharmacy operating models that center on patient engagement best position pharmacists to offer clinically relevant and financially sustainable pharmacist-provided care, as the marketplace shifts to value-based care. Medication synchronization, when implemented as part of a holistic approach to patient care, is an effective and proven foundation for transitioning to a pharmacist-provided care model. However, the use of volume-based prescription fulfillment and reimbursement models limits the expansion of pharmacist-provided care. This threatens pharmacists’ position as valuable clinical care team members, who serve the needs of patients, purchasers and payers and demonstrably improve outcomes.

Value-Based Payment in Pharmacy Practice

Pharmacists and their research partners, who have been early adopters of value-based, pharmacist-provided care models, say the transition has:

• established new partnerships with payers, employers and other clinicians;
• improved medication adherence and clinical outcomes in complex chronic diseases;
• increased patient participation in preventive health services, such as immunizations;
• improved performance on quality measures; and
• decreased total cost of care and patient utilization of care.

Source: Sync-to-Serve Survey Responses

Train frontline pharmacists to successfully transition to a pharmacist-provided care model.

Many frontline pharmacists are not confident they have the education and resources to successfully transition to a pharmacist-provided care model.6 To help them embrace this model, pharmacist employers should provide training programs that keep clinical skills current, explain new reimbursement processes and outline processes to overcome information technology and data access issues necessary for evaluating and caring for patients. Trainings should ensure pharmacists understand the quality measures by which health plans are evaluated and the implications for pharmacist-provided care delivered in partnership with payers.

Training and Payment: The Chicken or The Egg

Pharmacy organizations are hesitant to invest in training and education to support frontline pharmacists in the transition to pharmacist-provided care models until it is clear that care will be reimbursed. At the same time, payers are hesitant to reimburse for this care until they are confident pharmacists are appropriately trained and educated. Pharmacy organizations and payers together should share risk to solve this challenge.

Source: Sync-to-Serve Survey Responses

Optimize efficiencies and efficacy of care delivery to allow pharmacies to be profitable while delivering valuable care.

In the shift to value-based care, pharmacists must identify a sustainable balance between the time and resources required to provide quality patient care and the reimbursement for those services. Pharmacists should partner with payers to develop efficient and effective care delivery that improve outcomes and appropriately reward pharmacists. By leveraging clinical practice guidance and standardized checklists and toolkits from credible organizations like the American Pharmacists Association, pharmacists and payers can determine which efficient and high-value care services to incentivize.

Standardize patient engagement and care delivery to provide consistent clinical care and optimal outcomes across diverse patient populations.

Pharmacy organizations should standardize how pharmacists engage patients and provide clinical care, including medication synchronization, medication therapy management, medication optimization and other services and interventions. This standardization should occur within and across chains of pharmacies. A consistent care process across pharmacies at a fundamental level will provide patients and payers with positive, predictable and reliable care experiences with optimal outcomes without inhibiting innovation or problem solving.

Educate stakeholders about pharmacists as essential, effective and accountable care providers.

Pharmacies, pharmacists and the professional and trade associations that represent them should expand efforts to promote community pharmacies as essential and effective settings for patient care. Backed by a growing set of case studies and data that demonstrate the value of pharmacist-provided care, stakeholders throughout healthcare can benefit from care delivery partnerships with pharmacists, including:

• insurers and other payers pursuing high-quality, low-cost care;
• other clinicians and providers seeking effective team-based and accountable care partnerships;
• employers and other health care purchasers designing care benefits;
• patients and caregiver organizations seeking patient-centered services; and
• foundations and advocates focused on accessible, affordable care.

Pharmacist-provided Care as a Total Cost of Care Solution

A pharmacy chain connected with employers, providers and payers to educate each stakeholder group on the role pharmacists could play on the clinical care team. These education efforts led to the establishment of agreements between providers, payers, and employers in which pharmacists provided care to lower the total cost of care for patients and employers. Payers targeted patients and selected high-performing network pharmacies to deliver pharmacist-provided care. Pharmacists provided patient-centered disease state management care and used tele-pharmacy to address the needs of rural patients. The pharmacies were evaluated on their performance and contribution to lowering the patients’ total cost of care compared to the previous year.

Source: Sync-to-Serve Survey Responses