Embedding Clinical Pharmacists in Primary Care Practices

Primary care practices are benefiting from integrating clinical pharmacists in their practice. One study found a reduction in the number of medication-related problems and the use of acute health services when a clinical pharmacist provided medication management services in a community-based primary care practice. Another study found that compared to usual care, annual per-patient health care costs were lower when pharmacists were added to primary care teams.

On top of these benefits, there is an additional incentive in the state of Maryland. The Maryland Primary Care Program (MDPCP) offers a per beneficiary per month payment directly from the Centers for Medicare and Medicaid Service (CMS) to cover care management services. For 2024, primary care practices in the program will receive care management fees ranging from $9 to $100 per beneficiary per month depending on the track. The care management team must be interdisciplinary and may include pharmacist services, health and nutrition counseling services, behavioral health specialist services, referrals and linkages to social services, and support from health educators and Community Health Workers. While having pharmacists on the care management team is not mandated, primary care practices are choosing to include them. Pharmacists can provide services (see Figure 1) as determined by the primary care practice, and the needs of the population.

Figure 1. Example activities of a clinical pharmacist in a primary care practice

Nationally, CMS’s quality payment programs may also incentivize the inclusion of pharmacists in primary care practices. The Merit-Based Incentive Payment System (MIPS) creates an opportunity for pharmacists to improve and document achievement of quality care and reduce the burden on physicians. This and other clinical pharmacy activities are explored in a strategic business plan. Additionally, telehealth enables pharmacists to see patients across practice locations and provides primary care practices with flexibility to contract for a certain percentage of pharmacist time.

There is growing interest in embedding pharmacists in primary care practices. Aligning incentives with pharmacist activities can maximize outcomes.

References

1. Roth MT, Ivey JL, Esserman DA, Crisp G, Kurz J, Weinberger M. Individualized medication assessment and planning: optimizing medication use in older adults in the primary care setting. Pharmacotherapy. 2013;33(8):787-797. doi:10.1002/phar.1274
2. Simpson SH, Lier DA, Majumdar SR, et al. Cost-effectiveness analysis of adding pharmacists to primary care teams to reduce cardiovascular risk in patients with Type 2 diabetes: results from a randomized controlled trial. Diabet Med. 2015;32(7):899-906. doi:10.1111/dme.12692
3. Applying to Participate in MDPCP in 2024. Health.Maryland.gov. Accessed November 14, 2023. https://health.maryland.gov/mdpcp/Documents/Applying_to_Participate_in_MDPCP_2023.pdf
4. Yon K, Sinclair J, Bentley OS, Abubakar A, Rhodes LA, Marciniak MW. Impact of quality measures performed through pharmacist collaboration with a primary care clinic. J Am Pharm Assoc (2003). 2020;60(3S):S97-S102. doi:10.1016/j.japh.2020.01.011
5. Norton J. The use of clinical pharmacists in primary care practices. Published September 2020. Accessed November 14, 2023. https://assets-us-01.kc-usercontent.com/153a3bbc-a15d-00f2-59d8-80b3fe8a0bbc/600c870a-28b7-4393-9d3e-46e5cb2ddac1/FACMPE-Paper-%289-2-2020%29.pdf