The Patient-Centered Medical Home and ACOs...What Should Be the Pharmacist's Role?

New health care models offer collaboration and risk sharing among health care professionals.

The Affordable Care Act (ACA) will bring us health care reform, although there is no agreement on the specifics of this reform and when it will finally occur. The fact that pharmacists can provide leadership to the reform process has been asserted by our pharmacy leaders. Will our practitioners step up and show that leadership as well? Where should they start? Should we take risks and advance new ideas or try to protect what we have?

I suggest that a good place to start is proposing the role of the pharmacist in the patient-centered medical home (PCMH) and the accountable care organization (ACO). As we help define that role, we must talk about roles that will improve quality while reducing unnecessary costs.

One approach to accomplishing this goal is the ACOs, which were established by the ACA and are slated to become operational in 2012. ACOs are a new type of integrated care and payment model bringing together providers across care settings in a new “risk-sharing” arrangement.

The PCMH is considered by many to be another promising approach to delivering safe, high-quality, cost-effective primary care to all—ranging from healthy people to those with chronic diseases. The PCMH model was actually introduced as the Medical Home concept in 1967. It is led by a physician/practitioner and provides comprehensive and coordinated care on a long-term basis. As these newer models become more common, will the pharmacist become a member or will others provide the patients’ drug therapy needs? The answer to this question will impact pharmacy’s future significantly. I am concerned that too many pharmacists are spending too much energy holding onto the current dispensing practice model instead of investing time and money on establishing a new model.

When I became a pharmacy association executive, one piece of advice I was given was “Make sure you take care of independent pharmacy, because as they fare so will the profession.” Because these pharmacists are more “invested” in the profession than the employee pharmacists, they often give more back to the profession. I have observed that to be true in some situations. However, much of pharmacy’s volunteer leadership comes from employee pharmacists, so their needs cannot be ignored. In fact, I believe that unless we focus more on collaboration than competition within pharmacy we will have real difficulty moving forward quickly.

Will pharmacy practice as we know it be “business as usual” or will we have to begin addressing real change? One area that concerns me is how pharmacy will be integrated into the PCMH or the ACO. There may not be a “one size fits all” approach—but some type of formal relationship will be required. What advice would I give to those working on the incorporation of pharmacists into the PCMH and the ACO? It would be to make sure you position pharmacists to take care of the patient. So, if health care in the new model will be delivered in the PCMH, how should pharmacists be positioned to be able to take care of patients?

Will pharmacists become employees of medical homes as the predominate model or will local pharmacies contract with PCMHs to provide that care? In ACOs, will networks of pharmacies be owned by the ACO as the predominate model or will local pharmacies be contracted to provide patient care? To me, these will be the critical questions to be answered by our profession over the next 5 years.

If I were practicing community pharmacy today, I would be exploring ways to get my pharmacy integrated into a PCMH or ACO. I would be talking to the physicians in my community to see how they are trying to position their practices. I would be watching what the health systems in my area are doing to become an ACO. And I would be talking to local business leaders to see how they are thinking about providing employee health care benefits. In asking these groups questions, I would keep reminding myself that changes usually come from the periphery, where people are not invested in maintaining the current model.

If there are many PCMHs or ACOs already established, I would be talking to them to see how I might become involved in their network. I might even suggest some type of a risk-sharing arrangement to demonstrate that my interest is sincere.

Additionally, I would make sure I was growing clinically, too, and obtaining whatever credentials I could to differentiate myself from other pharmacists. Rather than wishing for the return of the “good old days,” I would be excited by the opportunity to grow professionally and be open to changing my practice model.

The only thing certain about tomorrow is change. Let’s work together to make sure the changes position pharmacists to take care of patients. PT

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.