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By Monica E. Oss

Traveling around the world gives you a different perspective on health care. In France and Spain, for example, pharmacists provide a wide range of primary care services. That is happening, much more slowly, in the United States. The shortage of primary care professionals is forcing policy makers to take another a look at the training and skills of pharmacists. In 47 states and the District of Columbia there are collaborative pharmacy practice agreements that allow pharmacists to manage diabetes and other chronic illnesses, and a new pilot in Rhode Island allows pharmacists to provide follow-up care for people suffering from addiction (see RI Hospital Leads Trial Of New Model For Pharmacies In Opioid Care and In Rhode Island, Some Get Addiction Care At The Pharmacy). And there are attempts across the country to expand practice acts and scope of practice to allow pharmacists to extend care.

This raises the question of whether – and how – specialty provider organizations should rethink the role of pharmacists on their care teams. That was the focus of a recent briefing titled As Behavioral Health Care Moves From Volume To Value, Integrated Pharmacy Offers An Unexpected Edge featuring Steve Ronik, M.D., chief executive officer of Henderson Behavioral Health and Melissa Odorzynski, PharmD, senior vice president and general manager of Medication Management Solutions for Genoa Healthcare. Hundreds of specialty provider organizations have in-house pharmacies. Executive teams of those organizations can use pharmacists in those pharmacies to improve their care coordination initiatives and reduce the cost of care (see Walgreens Pharmacy Adherence Programs Saved $164 Per Participant).

What are the enhanced roles that pharmacists can play? How do they add value? There are some state-specific roles for pharmacists. Depending on the state, pharmacists can administer a growing list of vaccines and they can provide injections for long-acting antipsychotics. Where rules have been expanded, pharmacists can participate in medication-assisted treatments programs. And pharmacists can initiate, monitor, and modify consumer drug therapy in states that have collaborative pharmacy practice agreements. Pharmacists in states that have these agreements can also order and interpret lab results, and the list continues (see Pharmacist Scope of Services). In addition, all pharmacists in an in-house pharmacy can enhance the care team in some specific ways. They can flag medication adherence issues, consult to and problem solve with clinical professionals on drug therapies, and use personal interactions with consumers for early identification of health management issues.

Flagging medication adherence issues: Adding a pharmacist onsite improved consumer experience at Henderson as well as medication management, said Dr. Ronik, who added that there were improvements in hospitalization and readmission rates as well (see Using Data For Performance Improvement In Value-Based Contracts). Various issues affect adherence—from finances to transportation limitations and family issues. Some people are more willing to talk with a pharmacist than other health care professionals (see Perspectives On In-House Pharmacies & Mental Health), about medication adherence barriers (see The Role Of Medication In Integrated Care Coordination—Now Front & Center).

Dr. Ronik, who has two pharmacies in outpatient settings, said the pharmacists’ follow-up with consumers has “been a Godsend for us,” because medication adherence—which can be part of a value-based contract—influences clinical outcomes. “It’s harder to measure and get a handle on medication adherence” but if consumers aren’t picking up their meds, you know they’re not taking them.

Collaborating with clinical professionals: This was described as a perk for pharmacists working onsite with specialty care professionals. “It’s about helping providers identify drug therapy problems and recommending solutions,” says Dr. Odorzynski. “That’s the way we can add value to the system. We have the ability to see and notice when someone’s not doing well and address it. We really can be an extension of the care team in terms of helping serve these patients.”

One reason: “Pharmacists are problem-solvers,” said Dr. Odorzynski. “That’s how we’re wired.” If there’s a transportation problem, solutions range from mail-order options to special packaging for complex regimes and alternatives to avoid side effects like a decreased libido.

Personal interaction with consumers: Talking with consumers is oftentimes most helpful to explain how medications are supposed to work—sometimes they take a long time to have an effect and people get frustrated or they work quickly, people feel better, and stop taking them, explained Dr. Odorzynski. “Calling consumers for refills or to check in gives pharmacists an opportunity to address barriers in personalized, customized way,” she said.

We’re also seeing an increasing role of pharmaceuticals in disease state management and in health budgets. And, for managers of specialty provider organizations looking to lead integrated care coordination contracts, the ability to maximize the value of pharmaceuticals. For more on the role of medications and medication management, check out these resources in the OPEN MINDS Circle Industry Library:

  1. Cigna Reports Combined Medical, Pharmacy & Behavioral Benefits Reduces Annual Costs By More Than $207 Per Covered Life
  2. Albertsons Expands Partnership With Genomind For Genetic Testing For Mental Health Medication Management
  3. Person-Centered Approach To Dementia Care Cuts Antipsychotic Use For Over Half Of Residents
  4. Express Scripts Announces Digital Formulary
  5. 12% Of Elderly Consumers Take 10 Or More Medications Per Week
  6. Sunovion Announces Results From Its Open-Label Extension Study Of Schizophrenia Treatment
  7. Diplomat, OptumRx Combining To Advance Access To Specialty Pharmacy Care & Infusion Services
  8. Genoa Healthcare Opens 500th Pharmacy Serving Behavioral Health Patients
  9. Concert Pharmaceuticals Initiates CTP-692 Phase 2 Trial In Schizophrenia
  10. California Awards Medicaid FFS Prescription Drug Contract To Magellan

And join us February 12 for the session “How To Build Value-Based Payer Partnerships: An OPEN MINDS Executive Seminar On Best Practices In Marketing, Negotiating & Contracting With Health Plans” during the 2020 OPEN MINDS Performance Management Institute.

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