Better health, lower costs the result of incorporating pharmacists in the management of complex patients

Incorporating pharmacists into a team approach for care of patients who require specialty pharmacy services can help manage cost and improve medication adherence.

This is a finding of an approach to medication therapy management (MTM) services implemented at Froedtert & the Medical College of Wisconsin as part of an ambulatory pharmacy model of care in which pharmacists are embedded across the health system into teams to manage complex patients. Along with helping to coordinate care for patients with complex needs, the pharmacists offer medication education and pharmaceutical clinical expertise, according to Erika Smith, PharmD, ambulatory pharmacy manager, Froedtert & the Medical College of Wisconsin in Milawuakee.

“Health systems and pharmacy departments that take a proactive approach and are willing to actively manage complex patients should be included in managed care payment structures,” said Smith, speaking at the Academy of Managed Care Pharmacy (AMCP) meeting in a session entitled Using a Financial Model to Expand Medication Therapy Management to Specialty Patients.

Smith emphasized the need for active patient management to both improve quality of care and, importantly, reduce cost. “The amount of money spent on specialty pharmacy care has increased significantly and become a financial management challenge for both payers and providers,” said Smith. “Ultimately, active patient management-including ensuring access to the most appropriate medications and achieving patient adherence to medications-will help drive value by delivering high quality care at an appropriate cost.”

During the session, Smith and her copresenter, Binita Patel, PharmD, director of ambulatory/retail at Froedtert & the Medical College of Wisconsin, described a pharmacy model of care used in the primary care setting that includes an expanded pharmacist role that provides a higher level of service to medication management through improved access, education and cost.

In the model, the pharmacists are involved in a variety of MTM interventions-post hospital discharge through visits and phone calls-medication monitoring, vaccinations (screening and administration in collaboration with outpatient pharmacy), and drug information (helping with follow-up on medication recalls, safety alerts, and shortages).

At one-year follow-up, outcomes of a study that looked at this model implemented in a primary setting showed that interventions resulted in better patient outcomes (e.g., avoid emergency department [ED] visits and hospitalizations) as well as reductions in cost (e.g., cost savings to patient). Based on the results, the predicted cost avoidance by avoiding ED and hospitalization visits totaled $604,000.00.

“Our results demonstrate a real-world example of a model that is beneficial for all patients involved, patients, providers, and payers,” said Smith, adding that their study highlights that a partnership between payers and health systems can lead to lower costs and better patient outcomes.