Pharmacy’s Role in the Patient-Centered Medical Home

San Francisco–There are numerous key benefits of integrating a pharmacy service into a patient-centered medical home (PCMH) or accountable care organization. Among them are lowering costs through collaborative patient care and improved adherence, increasing transparency of fraud and abuse, and lowering hospital readmissions.

At a Pharmacy Partnership Briefing session at the AMCP meeting, a trio of presenters explained how best to accomplish this in their presentation titled Launching an Effective Integrated Pharmacy Program for the PCMH at the University of Maryland Family Physicians. The speakers were Karen DeHeer, RN, clinical care manager, University Family Physicians, Judi Grupp, MS, MBA, president and CEO, Physicians Pharmacy Alliance, Inc., and Brooke Rawls, PharmD, RPh, senior vice president, product development and clinical initiatives, Physicians Pharmacy Alliance, Inc.

The key to a successful integration is to understand the basic elements of success. This includes identifying the most appropriate disease states and populations, medication reconciliation methods, and the tools required to develop a fully collaborative environment for all stakeholders.

Learning how to develop key measurements will ensure the success of the program. Required knowledge includes what data to collect and how to analyze the data to ensure the success of the program.

There are 6 forces driving the need for integrating pharmacy into the PCMH: (1) the aging of America; (2) challenging economics; (3) changing health conditions; (4) fragmented care; (5) movement of Medicaid from state managed to managed care organizations; and (6) the shifting of demographics and culture. One of the speakers noted that “only we have the power to impact this.”

The next portion of the presentation discussed the importance of centering on the patient by meeting pharmacy needs. In order to be fully patient centered, barriers and paradigms must be addressed and workflows, processes, and roles must be transformed. The importance of both on-site and off-site communication was stressed, as well as the need to individualize the patients by identifying populations.

Adherence barriers that need to be addressed for the program to effectively operate were discussed. The barriers include limited mental and physical energy, lack of transportation to pharmacy, needing to make multiple trips to the pharmacy, numerous subscribers, discrepancies between patient and provider in understanding treatment regimen, delays in obtaining medications, and knowledge deficits.

The session continued with case studies demonstrating pharmacy solutions and exactly how the integrated pharmacy service model should work. A 64-year-old Hispanic woman was helped simply through a better understanding of what medications she needed to take as a result of a phone call from a clinical pharmacist. Before pharmacist contact, the woman had low health literacy as a result of a poor understanding of her condition and medications. According to the American Medical Association, poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level, and race.”

A 56-year-old Caucasian male who was taking 23 different medications benefited greatly from a home visit and medication inventory. One of the most important results was educating the patient on pharmacy services, including advising him of after-hours support options to mitigate unnecessary trips to his provider or to the emergency department for medication issues.

One facet of pharmacy integration involves reconciliation and regimen assessment. Key measurements of this facet have found that on average, 2.2 medications are discontinued as a result of therapeutic duplication; the average cost per discontinued drug is $118 per month, saving more than $2800 per patient per year in drug costs alone; and 9.5% of patients are taking drugs at less than the recommended dose and 12.7% are taking drugs at more than the recommended dose.

In conclusion, the speakers reviewed the 4 key values of a successful integrated model: (1) be culturally aware; (2) drive down medical expense; (3) collaborate and provide visibility to combat fragmentation in healthcare; and (4) reduce discrepancies and duplicate therapies.