Integrated Pharmacy Program

San Diego—The Medicaid system includes patients described as complex, who comprise a challenging and transient group of patients. Managing this group of patients in the face of complications including lack of claims data, high rates of nonadherence, frequent hospital admissions, and cultural challenges have led plans to develop new techniques such as integrated pharmacies that work directly with the health plans, providers, case workers, and others to help manage this complex patient population.

Judi Grupp, MS, MBA, and Brooke Rawls, PharmD, of the Physicians Pharmacy Alliance (PPA) presented a Contemporary Issues session titled Integrated Pharmacy Impact at the AMCP meeting. Ms. Grupp is chief operating officer of PPA and Dr. Rawls is senior vice president, product development and clinical initiatives.

Ms. Grupp and Dr. Rawls opened the session with a definition of an integrated pharmacy model. The model is a medication management program that is focused on a given population with specific outcomes. It utilizes collaboration to connect case workers, providers, and clinical pharmacists with aligned outcomes, resulting in a resource for physicians and a patient tool designed for this particular population. Possible outcomes include targeted HEDIS or STAR outcomes, improved clinical outcomes, reduction in emergency department (ED) visits and hospitalizations, and reduction in care disparities. In summary, the speakers noted that an integrated model ensures physicians, clinical pharmacists, and case workers are working toward the same goal.

The ideal target populations are beneficiaries with multiple chronic illnesses who see an average of 13 different physicians each year and who fill 50 different prescriptions each year. These patients account for 75% of all hospital admissions and 72% of physician visits; they are 100 times more likely to have a preventable hospitalization than patients not in this population. Other target populations include patients with frequent visits to the ED or frequent hospital admissions.

The integrated pharmacy model begins with home visits to assess the patient’s medication inventory and current therapy regimen. The home visit also allows the pharmacist to assess barriers to adherence and health management and to account for discrepancies that may have occurred during transition in care. Other benefits include developing a trusting relationship with patients and becoming acquainted with care givers.

The pharmacist then conducts a review of in-home inventory and medication use reported by the patient and compares that data to the provider-assumed regimen and discharge instructions from transitional care. The pharmacist also conducts a review of the appropriateness, effectiveness, safety, and adherence to each medication and results of the assessment are communicated to the appropriate healthcare provider (specialist or primary care physician).

The resulting documentation of the provider-approved medication reconciliation includes clinical intervention strategies, confirmed diagnoses, and a care plan. The pharmacist then reviews the result of the medication reconciliation with the patient and explains the medication regimen.