The Goal is Optimized Patient Care

Provider status elevates the role of pharmacists on the health care team.

With the midterm elections over, this seasoned Washington policy wonk’s thoughts turn to…hockey! More specifically, they turn to the sage advice attributed to “The Great Gretzky” (actually, it was advice his father gave him): “Skate to where the puck is going to be, not where it has been.”

If we could all be so prescient, we might resolve our policy challenges with fewer center-rink fisticuffs and more multistakeholder team huddles. Fortunately, clues about where the puck is going are piling up fast.

As pharmacists make progress toward achieving provider status, teamwork will be crucial. First order of business: identify your teammates. Ideally, they will be local physicians, other prescribers, perhaps the heads of your state or local medical and nursing societies. Further, scan “accountable care” and “patient-centered medical home” conferences, and mine the agendas for contacts that may be in your backyard. (On most of these national programs, however, pharmacists will be few and far between.) Also, search for the “Innovation Advisors Program,” which lists more than 70 individuals hand-picked by the Centers for Medicare & Medicaid Services (CMS) a few years ago to help connect your innovative practice to other in-state (or nearby) change agents. As in pro hockey, the season for evolving models of care is still young, so it’s not too late to line up your teammates.

Second: do your pregame homework. No matter how well versed you are in the sport, you have to prepare for those team huddles. Is homework time at a premium? Look for the US map at http:// innovation.cms.gov and select your state under the headline, “Where Innovation is Happening,” to find hot pockets of emerging care models.

While you’re on this website, note that CMS is putting $840 million toward the Transforming Clinical Practices Initiative, which offers grants that would better incentivize activities at the heart of your current practice: enhancing prescriber—clinician communication to optimize medication use, improving coordination of care, and using electronic health records. For information on how to apply for a grant, go to http://innovation.cms.gov/initiatives/ Transforming-Clinical-Practices/. This grant opportunity closes January 6, 2015, so gather your practice partners and get crackin’!

In October, CMS’ request for information on “Health Plan Innovation Model Concepts” sought feedback on the pros and cons of Part D medication therapy management, better coordination between ACOs and Part D drug plans, and even medication therapy management in Medicaid. Kudos if you already weighed in, perhaps identifying lack of provider status as a challenge. The data collected through this initiative will be valuable in completing the part of your homework that includes familiarizing yourself with the opinions and experiences of other stakeholders. In our transforming health care system, we’re all teammates, shooting the puck toward the same goal: optimized patient care. Don’t forget to utilize the health information technology experts: they watch the on-ice action like a hawk, know each player’s strengths and weaknesses, regroup quickly if the puck misses, and are singularly focused on the goal.

You are probably quite familiar with the Medicare Part D quality measures, but what about the 2015 Medicare physician fee schedule, detailed in the November 13, 2014, Federal Register? Talk to your teammates about CPT code 99490 for chronic care management services. Your job is to read between the lines for conversation-starters with your practitioner-prescriber teammates. Can they really handle chronic care management without you on their team? Skate to where the puck is going to be. Hint: this includes looking into that new Transforming Clinical Practices Initiative grant opportunity, mentioned above.

Part of the experience of being a health care provider is learning about the needs of your patients. Greg Sachs, MD, wrote a thoughtful commentary published in the November 2014 issue of JAMA Internal Medicine entitled, “Improving Prescribing Practices Late in Life: A Task for All Clinicians.” In it, he observes that studies “raise questions about how tightly to control diabetes… and hypertension in older adults because of the risks of hypoglycemia and falling.” Sachs points to mainstream guidelines for chronic conditions that “have started to incorporate age, life expectancy, comorbid conditions and goals of care into their algorithms…The frail older patient with hypertension may choose less intensive blood pressure management,” he notes. You’ve been trained to detect such clinical, and personal, nuances; you counsel your patients about them, and provide timely feedback to prescribers, right?

This is your homework assignment: devise a plan to systematically share your patient-centered experience with other providers, who in accountable care practices should welcome all that pharmacists bring to the table.

Third, it’s important to remember to use the time on the clock wisely. How are you spending your time? Did you notice that another commercial accountable care organization popped up in your backyard? What about that new patient-centered medical home (PCMH)? More than 8100 PCMHs have been accredited by the National Committee for Quality Assurance. In Vermont, pharmacists spent 1 day a week in 5 PCMHs. They had an 86% acceptance rate by prescribers of their recommendations for drug therapy optimization. Moreover, this pilot’s cost-avoidance model found $2.11 saved for every $1 invested in pharmacists.¹ With a return on investment like that, it’s no wonder that Arizona’s Banner Health recently recruited for a PCMH pharmacist within their medical group clinics “to provide population-based disease management, patient and provider education and collaborative drug therapy management…to optimize medication therapy, improve outcomes, promote wellness, and disease prevention.” The word is out: pharmacists are essential players on the health care team.

N. Lee Rucker, MSPH, is principal and founder of Enhance Value in Bethesda, Maryland, to which she brings more than 3 decades of advocacy and public affairs experience serving on staff at national organizations representing consumers, pharmacists, the pharmaceutical industry, and physicians. She serves as senior advisor for the National Council on Patient Education and Information. From 2004-2013, Lee served as a Medicare Part D expert at the AARP’s Public Policy Institute. She has been awarded honorary membership in the American Pharmacists Association for 2014. Lee is a graduate of the University of Michigan and the University of North Carolina at Chapel Hill.

Article updated since print publication.

References

• Kennedy AG, Chen H, Corriveau M, Maclean CD. Improving population management through pharmacist-primary care integration: a pilot study. Popul Health Manag. July 16, 2014 [epub ahead of print].