What is a Population Health Pharmacist?

What is a population health pharmacist? Is it the:

• pharmacist behind the counter in the local pharmacy?
• pharmacist providing Comprehensive Medication Management (CMM) in a primary care clinic?
• pharmacist in pharmaceutical industry exploring how to incorporate social determinants of health in product development?
• health system’s pharmacist creating order sets for care pathway development?

Any or all of these can be correctly called “population health pharmacists,” a term that is being used with increasing frequency. But an encompassing definition is lacking.

The Oxford Language Dictionary defines pharmacist as “a person who is professionally qualified to prepare and dispense medicinal drugs.”

Wikipedia elaborates on this definition: “A pharmacist, also known as a chemist or a druggist, is a health professional who specializes in the preparation, properties, effects and use of medicines. The pharmacist provides pharmaceutical care to patients, as well as basic primary health care services.”

In 2000, the American Association of Colleges of Pharmacy mandated the Doctor of Pharmacy degree, or PharmD, to be the entry-level degree for all pharmacists.¹ Pharmacists, whether working in a commercial pharmacy, providing CMM, or working in industry, are professionals who have undergone five to six years of education and training.

While I was a medical student, “pharmacist” simply represented the professional dispenser of medications, whether at the commercial pharmacy or in the hospital pharmacy department. My understanding of the potential value of a pharmacist was influenced early in my career at the University of Maryland.

Rob Michocki, PharmD, my late colleague and fellow faculty member in the Department of Family Medicine, rounded with the hospital team and in the clinic and lectured to medical students and residents. Decades before these issues became widely recognized, Rob advocated for critical prescribing, and for questioning the evidence for use of the drugs that we were choosing. He pointed out the potential conflicts of interest generated by new drug promotions and our dispensing of samples in the office. Rob showed us the value of a pharmacist faculty member, and in many ways embodied an early “population health pharmacist.”

I developed and recruited a Population Health Pharmacy leader in my previous role as Chief Medical Officer for a large accountable care organization (ACO). The position required an ability to consume large amounts of data with our analytics team, and translate the information into clinical initiatives that promoted value-based prescribing. The job description included addressing drug prescribing by hundreds of physicians and advance practice providers. Provider practices were addressed and included promoting generic drug prescribing and deprescribing strategies to advance safety by addressing polypharmacy.

The role included collaboration with clinical leaders and pharmacists providing direct CMM services to patients. The Population Health Pharmacist interfaced with payers, was involved in promoting drug formulary adherence, as well as developed and implemented initiatives to promote value-based prescribing. For example, with increasing recognition that long-term proton pump inhibitor (PPI) use was both unnecessary and potentially harmful,² prescriber data identifying patients on long-term PPI therapy was presented to providers, who were educated about the harms and need to deprescribe. Subsequent changes in PPI prescribing were also monitored and reported. A basic understanding of applied health economics and outcomes research (AHEOR) was useful to interpret the literature on the value proposition of medications. That would inform and help pharmacy and therapeutics committees in formulary decisions.

The Population Health Pharmacist also interacted with pharmacy benefit managers for our ACO-employed population, promoting their formularies, and addressing patients’ challenges of drug denials.

When I joined the Jefferson College of Population Health Faculty three years ago, I convened pharmacists from across our health system who were performing population health activities to network. They included the ACO Population Health Pharmacist, pharmacists providing CMM in primary care practices, pharmacists in our AHEOR program, and a School of Pharmacy Director. The Fellows in our AHEOR program were sponsored by different pharmaceutical companies for their two-year training, which was focused on data, drug development, and research into population health impact. All of us were enlightened by the breadth of our “population health pharmacy” efforts.

A diverse group of pharmacists seek population health education in our programs. Some attend our five-day Population Health Academy to learn from an intense overview of population health. Typically, these pharmacists have recently been assigned the title of “population health pharmacist” by their organization and seek to develop a better understanding of population health—to apply to their new roles. Some pharmacists enroll in our Masters of Science in Population Health degree program. They bring their diverse roles and backgrounds to our classes, and enhance all of our students’ learning. Their diversity is reflected in their capstone projects, which range from exploring virtual clinical trials as a way to reduce costs while also reducing barriers to participation (and promoting a more diverse study population), to developing a new educational program to train pharmacy students in skills important for promoting value-based prescribing.

Despite their level of education and expertise, and their ready accessibility, pharmacists are undervalued in the fee-for-service reimbursement system; direct payment for CMM is limited³ and there is no direct clinical payment for activities that promote value-based prescribing on a population level. Evidence shows that pharmacists make a significant impact on patients’ health outcomes and overall health and reduce health care costs. There is ongoing effort to promote provider status for pharmacists, which would align reimbursement with the services pharmacists are trained to provide.⁴ In addition, as pharmacists’ roles in population health are expanding, new value-based care models recognize their role in achieving greater savings and improved quality of care. Those savings provide some funding for the incorporation of population health pharmacists into health operations and leadership roles.

References:

1. Credentialing in pharmacy: the council on credentialing in pharmacy, Am J Health Syst Pharm. 2001;58(1):69-76. doi:10.1093/ajhp/58.1.69
2. Nehra AK, Alexander JA, Conor GL, Nehra V, Nehra MD. Proton pump inhibitors: review of emerging concerns. Mayo Clin Proc. 2018; 93(2):240-246. doi:10.1016/j.mayocp.2017.10.022
3. Ferreri SP, Hughes TD, Snyder ME. Medication therapy management: current challenges. Integr Pharm Res Pract. 2020;9:71-81. doi:10.2147/IPRP.S179628
4. Pharmacy’s Top Priority: Medicare Provider Status Recognition. American Pharmacists’ Association. Accessed December 3, 2021. https://www.pharmacist.com/Advocacy/Issues/Medicare-Provider-Status-Recognition

I would like to dedicate this article to my late friend and colleague Robert Michocki, who passed away on October 15, 2019. Rob was ahead of his time, and showed all of us the value that a PharmD could bring to patient care, education, and ultimately population health.