Pharmacists can help control costs and improve patient care by working with primary care teams to optimize medication management.
Medication errors, unnecessary emergency room visits, preventable hospital readmissions — all of these health costs can be reduced through better medication management, and new collaborative care models can lead the way, said panelists at a congressional briefing here hosted by the Partnership to Fight Chronic Disease and the University of North Carolina (UNC) Eshelman School of Pharmacy.
“For every dollar we’re spending on prescription medications, we’re spending another dollar trying to resolve a problem due to that medication,” said Mary Roth McClurg, PharmD, MHS, of the UNC Eshelman School of Pharmacy in Chapel Hill, N.C.
Medications account for $310 billion in spending in the U.S., and optimizing their use through improved adherence alone could save $290 billion, McClurg explained. But medication adherence is not a simple problem. Chronically ill patients adhere to their medication regimen only some 33-50% of the time, she noted. High deductibles and rising copays create additional challenges.
“If you can’t afford it, you’re not going to take it,” added Kevin Ronneberg, MD, vice president and associate medical director of Health Initiatives at HealthPartners, a regional health insurer based in Bloomington, Minn.
Some patients may be eligible for copay assistance programs, noted Troy Trygstad, PharmD, PhD, MBA, vice president of Pharmacy Programs at Community Care of North Carolina, in Raleigh-Durham.
Comprehensive medication management (CMM), also called medication therapy management, can help curb overall spending, while improving patients’ experiences and their outcomes. McClurg is the principal investigator of a study that aims to evaluate CMM and determine best practices for integrating clinical pharmacists into primary care to optimize medication use.
The CMM model involves regularly reviewing and monitoring participating patients’ medications for appropriateness, effectiveness, safety, and convenience, with the goal of understanding the impact on quality of care and the return on investment for primary care teams that collaborate with a clinical pharmacist.
To illustrate, Ronneberg, whose health plans have invested in a similar program, shared the story of “Annie,” a Medicare beneficiary in her mid-70s. Annie has early-stage Alzheimer’s, chronic kidney disease, and congestive heart failure. She had gone to the hospital five times in the span of 2 years before her provider introduced her to a pharmacist who conducted a comprehensive medication review. The pharmacist helped her switch from an injection therapy for her diabetes to an oral medication with equivalent outcomes. The pharmacist also taught Annie to weigh herself to see if she was putting on fluid — an indication that her heart medications were not being used effectively and that she might be headed for an emergency room visit — and helped her sign up for a mail order program to have prescriptions delivered. In 4 months, Annie had not visited a hospital or an emergency department and her health was improving, Ronneberg said.
A one-time visit with a pharmacist is akin to sailing, said Ronneberg: Traditionally, pharmacists help patients push off the dock, steer it in the right direction, and then say, “good luck,” he explained.
“And we know that the wind comes up the waves and the currents.” So, a model that enables providers to help patients correct course through education and more frequent monitoring can help both patients and providers achieve better outcomes.
A review of such programs for commercial members in his own health system found an average of $1,400 in savings per member per year, as well as $4,500 in annual savings for high-risk members, Ronneberg added.
Similarly a study that evaluated diabetes management of one large government employer, which compared one group that had received medication therapy management (MTM) with a similar population not participating in such programs saw a near doubling in “optimal diabetes care” among members who received MTM.
One core challenge is the payment model. While health systems are moving away from fee-for-service payment, that style of reimbursement still persists.
In a fee-for-service environment, physicians are paid each time a patient visits to adjust a medication whereas in certain alternative payment models, physicians are rewarded for managing total cost of care.
Such models will work best if performance measures are aligned for all providers, said Trygstad for one medication. “And you’re saying ‘Hey, you guys need to work together.’ It doesn’t make any sense,” he said.
Having shared metrics across providers who are expected to work together will create the right economic incentives to make such medication management programs most effective, he noted.
Another challenge is weak interoperability — i.e., electronic medical records that don’t speak well to one another across providers.
Yet when primary care doctors who are docked for poor performance outcomes, such as hospital readmission rates, learn that pharmacists can help doctors lower such rates, they quickly find ways to help pharmacists access their electronic medical records, Trygstad said: “All of a sudden the legal [barriers] and everything melts away because you’ve got a business incentive to work with somebody.”
— LAST UPDATED 10.06.2016
Article by Shannon Firth, Washington Correspondent, MedPage
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