As the Department of Health and Human Services continues its shift towards an outcomes-based payment model, one small health system is working with its pharmacists to create an innovative disease management initiative to minimize hospital readmissions and improve health status for its most complex – and costly – patients.
The Comprehensive Health Management program developed by Martin Health System in Stuart, Fla., establishes a progressive role for pharmacists to work directly with older, chronically ill patients. Integrating these neighborhood-based professionals into the system’s primary care practices improves management of patients with chronic diseases such as diabetes, obesity, heart and lung disease, according to David Harlow, Pharm.D., assistant vice president for professional services, clinical imaging, clinical laboratory, clinical pharmacy and disease management at Martin.
“Physicians in today’s fee-for-service world simply do not have the time to devote to them,” he said in a phone interview. “Secondly, there’s little incentive for them to do so.” Even with Medicare payment authorizations for chronic disease management that went into effect on Jan. 1, Harlow noted that it can’t create more time in the clinician’s day.
Older patients with multiple chronic conditions are at highest risk for hospital readmissions, Harlow said. “We spend enormous amounts of money and we see them come through again and again. It’s really that wheel that is the challenge for health care as we know it.”
The health management program puts a different kind of team in place, creating a more proactive role for the pharmacist. They meet with patients in person and speak regularly by phone to educate them about their conditions, proper use of medications and devices such as glucose meters, provide in-network and community resource referrals and work with patients and family members to identify needs – with the goal of reducing readmissions and improving overall outcomes.
“We’re not taking the patients away from the physicians,” Harlow explained. “Pharmacists become their eyes and ears and partners in this with the patients, sort of a touchstone.” This frees up opportunity for the primary provider to see more acute care patients while also becoming better informed on how those with chronic conditions are doing between visits.”
Harlow said unlike some other pharmacy-based programs, Martin’s pharmacists use the same evidence-based care plans already in use throughout the health system. Patient data and notes are stored in existing electronic medical records, providing an easily accessible tool for clinicians to track compliance and outcomes. Serious issues are flagged and can be addressed right away.
The pilot program began in mid-2014, and is underway in two of the system’s locations, managing about 100 of the most at-risk patients. Martin Health is working with researchers at Virginia Commonwealth University to collect and quantify outcomes data for the fledgling initiative.
Health care costs caused by improper and unnecessary use of medicines exceeded $200 billion in 2012, according to a report from the IMS Institute for Healthcare Informatics. That added up to about 8 percent of U.S. health care spending that year, enough to pay for the care of more than 24 million uninsured citizens. The report concluded that “improvements are possible only through collaboration among multiple healthcare stakeholders: providers, pharmacists, patients, payers, pharmaceutical manufacturers and policymakers. “
Community pharmacist engagement programs through several larger chains, including CVS/Caremark and Walgreens, were cited as potential models to improve adherence and therapy initiation. A pilot program by Walgreens accountable care organizations in 18 states expanded chronic disease detection and management by staffing in-store clinics with nurse practitioners and physician assistants. They screen and manage people with multiple chronic conditions and provide referrals when needed. In the first four months of existence, the ACO organizations, which manage health care for about 50,000 patients, demonstrated hospital readmission levels at half the national average.
“We are not a huge health system but we have developed something that is really relevant and will stand the test of time in today’s health care environment,” Harlow said. The program can easily be replicated by other health systems – several have already shown interest – and by accountable care organizations. “Not only does it make sense in terms of patient satisfaction, it has a really meaningful advantage in terms of patient choice and satisfaction,” he added.
Harlow would like to expand the pilot through a partnership with CMS, but said they have yet to take a look at the program, or even return his calls. “If we’re going to think about pharmacy and its role in the health system, we can’t just look at dispensing and dosing.”
- American Society of Consultant Pharmacists Fact Sheet
- CDC Program Guide for Public Health – Partnering with Pharmacists in the Prevention and Control of Chronic Diseases
- National Governors Association Paper: Expanding the Role of Pharmacists in a Transformed Health Care System
- This article from The Charlotte Observer on how N.C. pharmacists are helping to cut costs and boost care
- The Dartmouth Atlas Database on physician prescribing patterns, use, and cost by city, state, and region