Pharmacists Can Play a Pivotal Role in Providing Value-Based Care

At the National Association of Chain Drug Stores (NACDS) Total Store Expo (TSE) in Boston, Massachusetts, Anita Patel, PharmD, MS, vice president of Pharmacy Services Development at Walgreen Co., and Adam Chesler, PharmD, MBA, senior vice president of strategic initiatives at VillageMD, discussed the necessity of developing coordinated value-based care, as major issues that require coordination, such as rising overall cost of care and a growing elderly population, abound.

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Patel began the session by providing an overview of those issues. By 2030, 1 in 5 Americans will be over the age of 65, stretching the capacity of health care professionals. Additionally, 6 in 10 individuals have at least 1 chronic condition, with that number soaring to 95% when shifting analysis to those ages 65 and older. In addition, overall medical debt across the country have risen to about $4 trillion.

Combine these statistics with the fact that only 26% of the population have primary care providers, and “You can see that where the need for care is so much higher, access to care is continuing to drop,” Patel said.

The Centers for Medicare and Medicaid Services (CMS) is asking for Medicare and Medicaid beneficiaries and pharmacists to commit to being in value-based relationships by 2030, meaning that patient care and experiences should be universally put at the forefront to provide greater economic benefits. As a wave of regulatory and policy shifts occur, Patel emphasized that change from the inside out is necessary.

“The only way that we can take a fragmented health system and improve it is through partnerships and data,” Patel told the audience, noting that she was echoing a theme espoused at multiple events across the weekend at TSE.

Patel provided multiple potential strategies for stakeholders to successfully develop value-based relationships and care. Key to her suggestions is having the correct low acuity care services available, complimenting a patient’s primary care as part of the care team, helping business partners engage with patients, and engaging with patients on multiple fronts.

In a promising venture, Walgreen Co. partnered with VillageMD to embed pharmacists within Village Care Teams, taking care of patients utilizing a value-based care-centered treatment plan. The team saw a reduction in hospital readmissions over a 30-day period by more than 40% versus usual care for participants in the pilot, in addition to an average A1C reduction of 1.3% in patients with uncontrolled diabetes, according to Patel.

Patel dove into a series of considerations for pharmacists and value-based care teams, including emphasizing engagement between payors and providers, considering the scope of their practice and its operational capabilities, and evaluating payment pathways and medical billing. Implementing these could be a challenge. Overall, however, Patel said these initiatives are not out of the ordinary. She concluding by saying, “Pharmacy knows how to do this.”

Next, Chesler presented what he deemed the “view from the lens of primary care providers.” Chesler explained that the most important patients to a pharmacy practice aren’t “the patients you can reach [easily] or the people in this room – it’s the 20% of people that cause 80% of health care costs.”

Chesler spoke to the importance of identifying partners. One example he provided that emphasized this importance is the mental shift that occurred in which care providers want patients to be vaccinated for influenza, but they want pharmacists to administer them because the current payment model does not incentivize them to do so. To optimize care, treatment providers need to work with pharmacists to create a team of treatment providers that can lower costs overall and better health outcomes.

“Adherence is probably the biggest opportunity,” Chesler told attendees. The goal is to hit 80% for proportion of days covered (PDC), which is a method to measure medication adherence by Medicare. The method has been used by Chesler’s team for issues such as statins for cholesterol, non-insulin diabetic medications, and RAS antagonists for hypertension.

Collaborative practices can fill gaps in care and lead to less costs, with plenty of opportunity for pharmacists to help, according to Chesler. “We know when a pharmacy and primary provider work together we get higher star scores,” he told the session, referring to their methodology for judging care interventions.

Another example provided by Chesler looked at the small ways in which a connected, value-based care team led to better outcomes for a patient. In this case, the patient went to the hospital because they were hungry. It was arranged for the patient to receive deliveries of food, which Chesler initially scoffed at.

However, every time a patient lands in the hospital, it costs a primary care provider $14,000. Providing an easy intervention – food – to a patient can not only make them healthier and save them costs but save the hospital and care providers costs as well. Chesler said that this mentality led to him encouraging the hospital to send the patient food, which prevented them from consistent readmission to the hospital and high costs.

In addition, recommending and administering vaccines, organizing annual Medicare wellness visits (pharmacists are eligible health care professions to conduct these wellness visits), and initiating lab orders and preventative screenings are all examples provided by Chesler of preventative services where value-based care can make an impact.

“You can’t always reach every patient, but they show up to the pharmacy,” Chesler concluded, saying that value-based care was the key to closing these essential treatment gaps.

REFERENCE

1. Patel A, Chesler A. Insight Session: Leveling Up Pharmacy’s Role in Value-Based Care. National Association of Chain Drug Stores Total Store Expo. August 19, 2024; Boston, MA.