The past few weeks, we’ve written about the role of medication in integrated care coordination – and how important it is for managers of provider organizations to understand medication best practices, the relationship between consumer engagement and medication adherence, and consumer access to medications through their pharmacy benefits (see The Role Of Medication In Integrated Care Coordination – Now Front & Center, Understanding Pharmacy Benefit Design – Essential For Integrated Care Coordination, Pharmaceuticals – The Next Stop For Value-Based Pricing, and Thinking About New Service Lines? Think About The Role Of Medication). But one area we haven’t covered is how medications make their way to the consumer.
In 2016 there were an estimated 61,863 pharmacies in the United States. Of these, about 85% can be classified as a community-based retail pharmacy (located in a drug store, grocery store, or department store). Generally under this model, consumers interact directly with the pharmacist to fill prescriptions from physicians and clinicians. Of the remaining pharmacies, less than one percent are located in schools and universities or are corporate owned facilities; and about 14% can be classified as an “in-house” pharmacy, meaning that they are located inside a hospital, walk-in clinic, medical center, or nursing home. Under this model, pharmacies have more opportunities to interact closely with prescribers, have access to medical records, influence treatment, and monitor drug use patterns (see National Pharmacy Market Summary).
As we move towards more integrated, value-based models of care, there has been more interest in the in-house pharmacy model, particularly in outpatient mental health programs – see New Roles for Pharmacists in Community Mental Health Care: A Narrative Review; Expanding the Pharmacist’s Role in Mental Health Care; and Pharmacist Skills Support Mental Health Services. And, recent research published in the American Journal of Managed Care found that consumer medication adherence improved if they received treatment in a service location with a pharmacy on-site (see Medication Adherence 96% For Consumers At Mental Health Facilities With Co-Located Pharmacies).
For more on how an in-house pharmacy can impact care coordination for consumers, I reached out to Donald W. Bechtold, M.D., vice president of healthcare and integration and medical director at Jefferson Center for Mental Health. Jefferson Center is a $58 million non-profit behavioral health provider organization based in Colorado. Dr. Bechtold shared information about how Jefferson’s pharmacy operates, the benefits of their in-house pharmacy, and some of the challenges they face:
We operate an in-house community pharmacy wholly owned and operated by Jefferson Center — we might be most accurately called a clinical outpatient pharmacy. It’s licensed by the state as a retail pharmacy like Walgreens or other retail pharmacies, with the exception being that we are a non-profit. By operating in-house, we’re able to provide patients with a higher level of individual/customer service and care coordination across their continuum of Jefferson Center services than if they utilize community pharmacies. Patients like getting to know and dealing directly with our pharmacists and pharm techs rather than the large, less personal community pharmacies. Ours is much more mission driven than the larger for-profit chains.
The biggest benefit is that we have options to provide for patients’ medication needs. Managing our own pharmacy makes us the decision maker in providing medication therapy. We focus our $4-$8 generic medications list on psychiatric medications, although we carry the full spectrum of medications and can service all of the pharmacy needs of our patients. Historically, pharmacies have generated revenue over expense for Jefferson Center, although that’s getting more difficult due to issues such as decreasing reimbursement rates, direct and indirect remuneration (DIR) fees, tightening insurance networks and state Medicaid issues related to reimbursement for injectable medications.
Another piece — within many current value-based payment models, which Medicare Part D payers currently use (percent of days covered for statins, diabetes meds, blood pressure meds, and high risk Beers criteria meds), community mental health pharmacies are at a disadvantage and often get penalized for working with a difficult patient population and many high-risk meds.
As the use of value-based care management models grows, we’ll continue to see greater consideration of how medications and pharmacy benefits fit into the value chain. This market demands that executive teams have an understanding of, and an ability to manage, medications and pharmacy costs (see Understanding Pharmacy Benefit Design – Essential For Integrated Care Coordination).
For a great discussion on integrated care models, join us on June 7 at The OPEN MINDS Strategy & Innovation Institute for the keynote, “Keys To Success With Integrated Care Models For Consumers With Complex Behavioral Disorders” from Ian A. Shaffer, M.D., MMM, CPE, vice president & executive medical director of Behavioral Health at Healthfirst.