If you are interested in population health in the United States, you may have noticed an alarming finding from the CDC in December, 2016. The agency reported a decrease in life expectancy for the first time since 1993, by 0.1 years from 2014 to 2015. Many target illnesses for population health programs also experienced increases in age-adjusted death rates, including heart disease, chronic lower respiratory diseases, stroke, diabetes, and kidney disease. Pharmacists and healthcare leaders are keeping their eyes on these trends and the developing opportunities created by incentivized value-based reimbursement programs from the Centers for Medicare and Medicaid Services (CMS), an approach likely to be followed by private payers.
Healthcare leaders searching for solutions in this challenging environment are considering new roles for pharmacists. Survey-based research from the Pharmacy Benefit Management Institute measured the rate of pharmacist involvement in Accountable Care Organizations (ACOs) (direct employment or contracted services) as 57% (2015) and 63% (2016). Pharmacy leaders should ask: Does our health system’s ACO have pharmacy at the table?
The Pharmacy Forecast is a great resource for supporting pharmacy leaders in strategizing new roles for pharmacists and has a great chapter on Population Health Management: Improving the Community to Heal the Patient. (http://www.ajhp.org/content/74/2/27)
This chapter provides important Strategic Recommendations for Practice Leaders that include:
- Leverage the pharmacy enterprise to achieve optimal medication adherence by high-risk patients. In pursuit of this goal, include risk-stratification techniques, telehealth applications, collaborative practice in clinics and community pharmacies, refill authorization, compliance packaging, and bedside discharge-prescription delivery.
- If your institution self-insures its employees for healthcare coverage, use that program to pilot innovative pharmacy services (such as targeted disease state management) that can be offered to other health-benefit plans.
- Create a pharmacy refill clinic that allows physicians to optimize their time with patients while improving medication use safety, adherence, and outcomes.
- Identify and implement ways for the pharmacy enterprise to actively contribute to your health system’s support services for high-risk patients, including efforts in telehealth, patient education, and motivational interviewing for improving adherence.
- Assertively incorporate a behavioral health component into pharmacist patient care, including chronic disease management and prescription assistance programs.
- Ensure that your pharmacy enterprise is actively addressing the opioid crisis through means such as an opioid stewardship program, effective opioid-diversion prevention, support of prescription-medication disposal programs, and promotion of improved public access to naloxone.
Additional Resources include:
- At the 2015 Conference for Pharmacy Leaders we had a break out session “Population Health and Patient-Centered Medical Homes: New Opportunities for Pharmacists”. You can access the slides at: http://www.ashpmedia.org/leaders15/agenda.html
Tom DiPiro, PharmD, MBA, MS
Pharmacy Data Analytics and Business Intelligence Coordinator
CHESS Health Enablement Solutions
References:
https://www.cdc.gov/nchs/products/databriefs/db267.htm
https://www.pbmi.com/PBMI/Research/PBMI_Reports/Accountable_Care_Organization_Reports/PBMI/Research/Store/ACO_Reports.aspx?hkey=805f5760-3fe3-4998-bc79-d5bdfa5c6d74