The benefit of integrating pharmacists into patient care teams

Clinical pharmacists integrated into patient care teams have the potential to improve medication measures as well as support cost-effective medication use, according to Laurie Wesolowicz, PharmD, director of clinical pharmacy for Blue Cross Blue Shield of Michigan.

Wesolowicz delivered a session titled Patient-Centered Medical Homes: Pharmacy Practice Model and Outcomes at the Academy of Managed Care Pharmacy (AMCP) meeting. In her talk, she highlighted patient-centered medical homes (PCMHs) as one evolving model of care and payment underway to meet the changing demands of the healthcare environment.

One major challenge is the anticipated shortage of primary care practitioners due to the increase in the insured population following passage of the Affordable Care Act, according to Wesolowicz. Into this environment, pharmacists have an opportunity to use their medication expertise as part of the patient care team. “Pharmacists as members of patient care teams have the ability to address medication use issues to improve patient outcomes, quality measures, and ultimately overall medical costs,” said Wesolozicz. “As an integrated member of the team, the pharmacist has access to critical data elements, other healthcare providers, and potential reimbursement sources.”

Among the challenges for pharmacists in the PCMH setting are the need to establish a relationship with physician organizations, primary care physicians, and Accountable Care Organizations (ACOs), and gain recognition by patients and employer groups of their value in therapeutic interventions. Also challenging will be gaining access to patient level clinical data, as well as the need to consider new potential roles and payment arrangements.

To provide an example of the integration of pharmacists into a PCMH, Stuart Rockafellow, PharmD, clinical pharmacist and clinical assistant professor, University of Michigan Health System (UMHS) and College of Pharmacy, Canton, Michigan, described a process used at the University of Michigan to embed pharmacists in the PCMH. Currently, 14 pharmacists are embedded in all primary care sites in the UMHS system. Time spent by pharmacists varies by clinical need and patient volume.

He reported on outcomes for 2009-2012 for patients seen in the Chronic Care Management Clinic (ie, those with diabetes, hypertension, hyperlipidemia, or asthma). A total of 1,579 patients were seen during this time, with 5,310 interventions. Time spent by pharmacists in this clinic ranged from one to six half-days, which included 30 minutes for clinic visits and 15-30 minutes for phone visits. Pharmacists were involved in working with patients to reinforce lifestyle changes, medication adherence, cost issues, monitoring medical condition and therapeutic response, and providing education on medications, devices and disease states.

Among the outcomes he reported on was reimbursement and provider satisfaction. Reimbursement for pharmacists in the PCMH increased each year from year one to year four, while it decreased from year one to year three when pharmacists used T-code billing. In addition, medical directors surveyed reported strong satisfaction with the inclusion of pharmacists and their impact on patient care.