On average, patients visit their community pharmacist 12 times more often than their primary care provider
As 2022 dawns, I asked a few healthcare leaders involved with the Get the Medications Right Institute to share some of their “must haves” for the rest of the year and beyond. I’m including 6 here, with the caveat that these are permanent goals for 2022 and beyond.
Must-have 1: The patient as a full participant
Patients should be recognized as full participants in the care team and they should participate in the development of their own care plan and medication plan.
“As far as I’m concerned, the worst-case scenario is to develop a care plan without active patient involvement and then present it to the patient as a done deal,” said Elizabeth Helms, director of the Chronic Care Policy Alliance and president. and CEO of the California Chronic Care Coalition. But that’s exactly what happens in most healthcare settings. “We are living in the worst-case scenario.
Must Have 2: Community Empowered Clinical Pharmacists
Community pharmacists are — quite literally — well positioned to meet the needs of the underserved, according to Michael Hochman, MD, primary care physician and CEO of Healthcare in Action, SCAN Group’s homelessness initiative.
On average, patients visit their community pharmacist 12 times more often than their primary care provider. This makes sense considering that over 90% of the US population lives within 5 miles of a community pharmacy.1
Clinical pharmacists, who are there in the community and know the patients, are an incredibly valuable and incredibly underutilized resource. He also sees an opportunity for clinical pharmacists to extend the reach of a practice beyond the walls of a practice.
“I think there needs to be a bit more outreach – the outgoing clinical pharmacist, through collaborative practice agreements,2 and see patients and help us manage their complex needs,” he said.
This is particularly the case for homeless people as they are unlikely to visit a clinic.
“They’re much more likely to respond if you meet them in the community rather than in a traditional doctor’s office.”
Must have 3: employers who push for better health plan coverage and think beyond the pill
Employers need to exercise their purchasing power and focus on implementing more innovative and comprehensive health plans with their medical carriers and pharmacy benefit managers. They should seek integrated benefit designs that consider whole-person care by investing in programs that impact the total cost of care.
In the context of drugs, that means “moving from the focus on the pill to the process of patient care,” said Karen van Caulil, PhD, president and CEO of Florida Alliance for Healthcare Value. “Current approaches are largely piecemeal, failing to address appropriate medication use, and employees have recognized that there is a better way to approach health plans and medication management within them.”
Employers need to think beyond the cost of a specific drug and consider how drugs are selected, managed and monitored, she says. Employers need a more comprehensive approach: comprehensive medication management (CMM).
We believe they are ready. A recent GTMRx survey of over 300 HR leaders found that 87% of respondents believe their company would benefit from a more innovative way of handling drug treatment issues and over 90% say that bringing in an expert in medications and/or a clinical pharmacist would be helpful to better understand medications. And comprehensive medication management provides precisely that.
Must have 4: Improved care coordination and follow-up
Admittedly, this is an ambitious objective, but nevertheless essential. For decades, care has been disconnected and fragmented. Payment silos create care delivery silos resulting in fragmented care with no one accountable for coordination or outcomes. Simply treating a patient, dismissing them, and not integrating activities or information into the continuum of care is dangerous and inappropriate.
“The delivery of value-based healthcare requires thoughtful coordination and monitoring, where patients are carefully managed to ensure the achievement of treatment goals,” said Steven Chen, PharmD, Associate Dean for Clinical Affairs, School of pharmacy and professor of clinical pharmacy at the University of Southern California School of Pharmacy.
This requires a multidisciplinary approach involving clinical pharmacists, physicians, other members of the healthcare team and patients, according to Chen. This requires “coordination of care that leverages the expertise of each member of the team”.
And today, when 80% of how we treat and prevent disease is with drugs, more often than not those teams should include a clinical pharmacist.
Must have 5: Primary Care Support
A recent Commonwealth Fund finds that the United States. lags far behind other rich countries in primary care.3 Americans are the least likely to have a regular doctor, a regular place of care, or a long-standing relationship with a primary care provider.
This is not surprising, given that only about 5% of health care spending in the United States goes to primary care.4 And yet, primary care is the only area of health care where increased supply is associated with better population health and more equitable outcomes.5
We are realistic; this is another ambitious goal. Adequate primary care support will not arrive by the end of the year. But what can – and must – happen this year are new investments in primary care.
One place we are looking for is the Center for Medicare and Medicaid Innovation (CMMI). Its mission is to test and implement value-based, person-centered, and team-based payment models that can support improved patient care and cost savings, which aligns with our goals at GTMRx.
CMMI can play a pivotal role in developing payment models that enable better access to team-based care and services that will optimize medication. Ideally, CMMI will formally integrate team-based care payment offering comprehensive medication management services designed to optimize medication utilization in Medicare.
Must have 6: wider adoption of CMM
I’ll end with my must have, shared by everyone I spoke to. And yes, it is an ambitious goal: to optimize medication use through comprehensive medication management in practice. It came back several times. So what is it? He is:
The standard of care that ensures that each patient’s medications (whether prescription, over-the-counter, alternative, traditional, vitamin or nutritional supplements) are individually evaluated to determine that each medication is appropriate for the patient, effective for the state of health, safe taking into account the comorbidities and other drugs taken and able to be taken by the patient as planned.6
Why drugs? More than 10,000 drugs are available on the market.
This is not surprising, given that medicine is how we treat most conditions. About 75-80% of office and outpatient consultations in hospitals involve drug therapy.7.8
Nearly 30% of adults take 5 or more medications.9
Unfortunately, this use of drugs is not optimized. As a result, more than 275,000 people die each year due to unoptimized drug use. The financial cost exceeds $528 billion per year.ten
This is why pharmacists must be part of multidisciplinary care teams.
CMM requires expertise. It’s not just about “the pill” or simple compliance. It is a holistic and comprehensive approach to health care.
“What’s important is that drug adequacy and effectiveness was a much more common problem than the problems that most people assume pharmacists deal with, such as medication adherence, polypharmacy, etc. .”, Chen said. “These are also obviously very important, but the fact is that pharmacists carefully consider the appropriateness of drug use and adjust treatment to help patients achieve their goal.”
The twin pandemics – COVID-19 and the opioid crisis – have revealed the urgent need for healthcare groups to align around a common mission: team-based primary care delivery that treats the whole patient for better care and better results.
And from our perspective, that starts with choosing the right drugs, that is, changing the way drugs are prescribed, managed and used. It’s the biggest must-have of them all.
About the Author
Katherine “Katie” Herring Capps, Executive Director and Co-Founder, GTMRx.
- Strand MA, Bratberg J, Eukel H, Hardy M, Williams C. Contributions of community pharmacists to disease management during the COVID-19 pandemic. [Erratum appears in Prev Chronic Dis 2020;17. http://www.cdc.gov/pcd/issues/2020/20_0317e.htm.] Prev Chronic Dis 2020;17:200317. DOI: http://dx.doi.org/10.5888/pcd17.200317external icon.
- A collaborative practice agreement creates a formal practice relationship between a pharmacist and a prescriber. CPAs specify which functions (beyond the pharmacist’s typical scope of practice) may be delegated to the pharmacist. These typically include initiating, modifying and/or discontinuing drug therapy
- FitzGerald, M, et al. Primary Care in High-Income Countries: How the United States Compares (Commonwealth Fund, March 2022). https://doi.org/10.26099/xz8y-3042
- Martin S, Phillips RL, Petterson S, Levin Z, Bazemore AW. Primary care expenditures in the United States, 2002-2016. Intern JAMA Med. 2020;180(7):1019–1020. doi:10.1001/jamainternmed.2020.1360
- National Academies of Science, Engineering and Medicine. 2021. Implementing High Quality Primary Care: Rebuilding the Foundations of Health Care. Washington, DC: The National Academies Press. https://doi.org/10.17226/25983.
- McInnis T, Webb E and Strand L. The Patient-Centric Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes, Collaboration in patient-centered primary careJune 2012
- McInnis, T. et al., editors. The Patient-Centric Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. 2nd ed., Collaboration in patient-centered primary care.
- Centers for Control and Prevention of Disasters. “Therapeutic use of drugs.” https://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm.
- Medication errors. June 2017, http://psnet.ahrq.gov/primers/primer/23/medication-errors
- Watanabe JH, McInnis T, Hirsch JD. Cost of prescription drug morbidity and mortality. Ann Pharmacother 2018;52(9):829-37. https://doi.org/10.1177/1060028018765159