Patient Advocacy: It's Not Just About the Medications

Relationships built on mutual trust and respect are the foundation for the Senior PharmAssist program.

An article in the Journal of the American Geriatrics Society stated more than 30 years ago that “knowledge alone is not directly related to compliance...feelings of close communication with providers are key.” Building on the relationships we have established with customers/patients and local providers is essential as pharmacists become more integrated in health care teams (accountable care organizations, patient-centered medical homes, etc). While technology may improve health care delivery, personal relationships continue to be the cornerstone for improving lives. Relationships built on mutual trust and respect are the foundation of Senior PharmAssist (SPA).

For 19 years, SPA has worked with pharmacists and others on staff—paid and volunteer—as well as other community partners to ensure that older adults in Durham, North Carolina, can obtain the medicines they need while avoiding the ones they don’t need. This mission is expanding with health care reform because new collaborative doors are opening.

Serving the Community

As a nonprofit organization, SPA relies on the support of foundations, governmental agencies, businesses, civic groups and faith communities, and individuals to accomplish its work. To date, our business plan has been that if we adequately share our participants’ stories and demonstrate that our interventions can change lives, financial support will follow. With health care reform, we believe that SPA will likely generate earned income as part of a “virtually integrated” health care team to supplement charitable donations. Remaining open to new ways of doing business is critical.

We began serving the Durham community in 1994 to address 2 public health concerns: 1) financial access to medications for seniors with limited incomes; and 2) medication-related problems in older adults. To this day, we continue to work closely with seniors, caregivers, and a wide range of health care and social service providers to deal with these issues by providing medication therapy management and direct financial assistance to pay for medicines for seniors with limited incomes. Many of our participants (more than 4000 since 1994) stay with the program for years, and this continuity of care nurtures rapport and trust. SPA is not owned by any hospital system or medical practice, and thus, we cannot bill “incident to” any provider. We are also not a Medicare Part B provider (ie, can’t bill for diabetes education). However, we have converted our interviews into an electronic format and stand ready to share data that might be useful to other health care providers.

We concentrate on 2 things: 1) being responsive to the needs of seniors with limited incomes; and 2) improving collaboration with community providers to help us all do our jobs better. We contract with a pharmacy benefits manager to coordinate our geriatric formulary ($2/generic and $5/brand), enabling seniors to maintain their relationships with community pharmacists and providers. We provide transport if needed to our office (every 6 months for medication management and annually for insurance counseling), and conduct home visits when necessary.

Unfortunately, most people don’t understand the value of medication management until they have experienced it, so our “carrot” for many years was that we actually helped pay for medicines. That is still true for some seniors, but we now offer 2 other carrots: reliable, unbiased Medicare insurance counseling and tailored community referral.

We learned early on that the social determinants of health (ie, poverty, education, housing, and inequality) shape the foundation of a community and the priorities of an individual. If someone is hungry or is worried about his/her grandchild who doesn’t have enough to eat or decent clothes to wear, she will likely not prioritize medication adherence or using the appropriate inhaler technique. We honor our participants when we listen to their priorities. Learning from and partnering with community referral specialists where you live will likely bring your customers/ patients tangible benefits and greater satisfaction with your care.

Insurance Counseling

Careful listening to our participants and other seniors convinced us to expand services in 2006 to begin Medicare insurance counseling. With the advent of Medicare Part D, we expanded our eligibility guidelines for financial assistance as we became the secondary payer for many seniors who had Medicare Part D as their primary coverage. However, Medicare Part D introduced major health literacy challenges and mind-numbing choices. Eventually, SPA became Durham’s Seniors’ Health Insurance Information Program (SHIIP), offering Medicare insurance counseling to seniors and adults with disabilities.

Every day in America, 10,000 Baby Boomers turn 65 and most need help to make good Medicare insurance choices. Ironically, some of our most important clinical interventions occur when our pharmacists sign off on insurance counseling because they are not only ensuring adequate coverage, but also that the medicines are appropriate. Offering insurance counseling is a big draw because the savings can be significant. For the past 4 years, two-thirds of the beneficiaries we have helped during Medicare’s annual election period needed to switch plans, for an annual average savings of $500 to $700.

While pharmacists cannot steer Medicare beneficiaries to specific plans, they can help them review their choices based on their specific medication needs. Alternatively, pharmacists can make referrals to their local SHIIP offices. This tailored help is another value-added service that builds mutual trust and respect.

Health care reform tenets recognize care coordination—and the relationships required to make this successful—as critical for improving health outcomes. For example, hospitals now feel pressure to improve discharge planning so that they are not financially penalized for higher than expected Medicare readmissions. This “hand-off” in the community is a real opportunity for pharmacists as medication reconciliation and transitions in care (ie, once discharged back home) can be challenging, with complicated, confusing, or expensive medication regimens.

Whether someone at Senior PharmAssist is discussing drug interactions, paying for medicines, counseling about Medicare advantage plans, or sharing local food pantry information—we try to focus on the top priority for the Medicare beneficiary. We are important to them because they are important to us.

Gina Upchurch, BSPharm, RPh, MPH, is the founder and executive director of Senior PharmAssist. She earned her bachelor of science in pharmacy and her master’s degree in public health at UNC-Chapel Hill. She also completed a residency in geriatric pharmacy practice at UNC-CH. She remains as adjunct faculty with both schools in the division of pharmacy practice and experiential education and the department of health behavior and health education, respectively. Between degrees, she served as a US Peace Corps volunteer teaching science in Botswana.