BCBSM aims to include pharmacists in PCMH care teams

A new initiative from Blue Cross Blue Shield of Michigan aims to create an environment where pharmacists from otherwise competing physician organizations and practice units have a non-competitive forum to collaborate on best practices and share ideas. 

The initiative would facilitate the coordination of pharmacy care into the patient-centered medical home (PCMH) practice, by piloting an initiative that integrates clinical pharmacists with physician practices across the state.

As part of the initiative, according to Laurie Wesolowicz, director of pharmacy services for Blue Cross Blue Shield of Michigan, pharmacists become part of the coordinated PCMH care teams.

“They will review medication changes, work with patients to help them understand their medications and how to use them, and help the care team with appropriate medication management,” Wesolowicz says. “The primary goal is to improve patient care and outcomes through integration of clinical pharmacists in direct patient care. Through this integration, we expect to improve performance on several quality and process-related measures such as HEDIS and QRS.” A strong collaborative relationship between pharmacists and physicians increases physician acceptance of pharmacists’ therapeutic recommendations, according to Wesolowicz. 

“Health plans can leverage this relationship to address many targeted quality measures for HEDIS, STARS, and QRS, especially those that are medication-related,” she says. “We hope the initiative enables pharmacists and the rest of the care team to improve care management for patients.”

 A new data registry will be developed where pharmacists will enter data about their encounters with patients, in turn allowing for a large and diverse dataset to be created and analyzed at the collaborative meetings, Wesolowicz says.  

“We believe this initiative adds value to the team-based care collaborations we are working on here in Michigan,” she says. “It supports both population management and patient-centered care. Collaboration among all points of care within the health system is vital to improving the health of our members.”

Next: A model for other plans?

The practice model was implemented in 2009 at the University of Michigan Health System (UMHS) by Hae Mi Choe, director of pharmacy innovations and clinical practices for the health system. The model places pharmacists in already-established PCMH settings to help patients manage diabetes, hypertension, and dyslipidemia, according to Choe.

“In the past, pharmacists could provide medication-related education and monitoring if requested by the patient’s physician within the patient-centered medical home,” Wesolowicz says. “Certain reimbursement codes were available to support a limited number of medication-related pharmacist clinical services. This initiative was developed to provide a framework to more effectively integrate clinical pharmacists into care teams that will be sustainable.”   

Wesolowicz believes this initiative can be a model for other plans. “Plans can gather providers-both primary care practices and pharmacists-to establish goals and protocols,” she explains. “They should have an objective coordinating entity to convene and guide the consortium and use the registry and dialogue among participants to identify and disseminate best practices. In this case, we are using the University of Michigan Health System.”

After the initiative’s first year, all 46 physician organizations that participate with the Blue Cross Blue Shield of Michigan patient-centered medical home program are expected to be phased in over a three- to four-year period.

As more physician organizations join the initiative, information will continuously be added into the data registry.

“This will give us a rich, valuable dataset from which physicians and pharmacists can develop optimal practice patterns and guidelines that improve compliance, cost management and effectiveness,” Wesolowicz says.