There was an interesting tidbit in the ASHP daily briefing I get this morning about Medicaid Expansion under the Affordable Care Act in Oregon. Quoting the Portland Business Journal the article identified that Medicaid Expansion has resulted in overwhelming the primary care community and was now “trickling into increased demand for specialty services.” The same blurb indicated Oregon being “chronically short” of physicians. According to the original article, Oregon Coordinated Care Organizations (is that an ACO under a different name?) had taken in more than 360,000 new members after the criteria for inclusion were expanded to include adults at up to 138% of the poverty level.
My first reaction was that this was both anticipated and understood in discussions at the PPMI summit in November of 2010! My second reaction was to the absolute dearth of any mention of pharmacists (or others!) filling in the gaps in primary care coverage being experienced. Of course, the article was heavily physician-focused, but I find myself wondering why anyone would be “surprised and overwhelmed” by a physician shortage that has been being predicted for nearly four years.
So how do we step up to the plate when it appears that we are not even being invited to play on the team? I would hope that representatives of state pharmacy organizations, and/or schools of pharmacy, might approach the management of these CCO’s and try to set up both services and traineeships that would provide some of the primary care services on a demonstration basis. It would be interesting to see if the “minute clinic” models set up by a couple of the major chain drug stores would help. In a white paper on pharmacist interventions for medication adherence, Dr. Sharrel Pinto describes an “Adherence Pharmacy” practice which includes, among other things, an appointment-based relationship between patients and community pharmacists that has patients coming to pharmacies regularly to meet with pharmacists and evaluate their management of their chronic disease states. He describes this as creating an “… ongoing conversation with each patient, caregiver and prescriber…”.
It seems to me that we as a profession have an opportunity here to solve a problem that isn’t likely to go away any time soon. How do you think we should go about it?
Dennis A. Tribble, Pharm. D., FASHP
DATdoc@aol.com
(386) 481-8166
The ideas expressed herein are my own, and not necessarily those of ASHP or of my employer