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Pharmacists Integral to Creating Medical Home Models

Stephen M. Setter, Pharm.D., CDE, CGP, FASCP, speaks with an elderly patient.

AS HEALTH CARE REFORM GETS UNDER WAY, hospitals and health systems across the country are looking into the viability of implementing the Primary Care Medical Home (PCMH) model. In PCMHs, provider-led teams of health care professionals provide coordinated, patient-centered care. The provider is often a physician, whose office acts as a kind of care hub, but much of the direct care is delivered by a multidisciplinary team.

Pharmacists’ Roles Changing

With more than 18 states currently participating in PCMH pilots, the model stands to make a deep impact on the way that care is provided and on the pharmacist’s role as an allied health professional.
Stephen M. Setter, Pharm.D., CDE, CGP, FASCP, associate professor of pharmacotherapy at Washington State University, Spokane, sees the PCMH model as a golden opportunity for pharmacists.
“Pharmacists will be able to use their training to the utmost in this model,” he said, adding that the challenge is simply getting a foot in the door with providers. “Pharmacists are often reactive in the way we provide care,” he said. “We find errors or interactions, but that is downstream. In the medical home model, we can be right at the point of care.”

L. David Harlow III, R.Ph.

Pharmacists need to be more proactive in communicating their expertise to providers, according to L. David Harlow III, R.Ph., director of pharmacy operations at the Carilion Clinic’s New River Valley Medical Center, Christiansburg, Va., and Tazewell Community Hospital, Tazewell, Va.

“Physicians are just not familiar with what pharmacists are qualified to do,” said Harlow, “and that’s just as much our fault, because we have not gotten
the word out.”

Evidence and Incentives

The evidence is there to support pharmacist involvement in multidisciplinary models like PCMH. Studies have shown that pharmacist-provided direct patient care improves patient outcomes across several disease states, and that patients cared for by a team that includes a pharmacist have fewer hospital readmissions.¹

Troy Trygstad, Pharm.D., MBA, Ph.D.

As the Centers for Medicare and Medicaid Services roll out “accountable care” projects, the financial incentive for including pharmacists in care teams will grow, as well. Accountable care makes providers responsible for ensuring that patients do not return with preventable complications, such as venous thromboembolisms after orthopedic surgery. If a patient returns with a condition noted under accountable care, the provider will not be reimbursed.

“That changes the equation completely,” said Troy Trygstad, Pharm.D., MBA, Ph.D., director of the Network Pharmacist Program at Community Care of North Carolina in Raleigh. “Now you have business reasons for a multidisciplinary team. Physicians need help in providing the deliverable, and they’re asking, ‘Who can you give me?’” Harlow notes how pharmacists are a natural choice for reining in health care costs.

“Twenty percent of the patient population uses 80 percent of the dollars in health care,” he said. “They are the patients with chronic diseases like diabetes and cardiovascular disease—the same things that account for the drug dollars. If you think about that in primary care, those patients take the most time, their medication regimens need the most tweaking, and they are most likely to relapse to the hospital if their medication issues are not corrected.”

Even in smaller medical practices, scheduling patients to come in and see a pharmacist can go a long way toward addressing those issues, he added.

Cushioning the Impact of Health Care Reform

The cost-effectiveness of involving pharmacists in the PCMH model is one reason ASHP worked so hard to obtain appropriate recognition for pharmacists in health care reform legislation, said Joseph M. Hill, ASHP’s director of federal legislative affairs.

Gretchen Tong, Pharm.D., discusses a patient’s medications with a University of North Carolina Family Medicine physician.

“Our initial accomplishment was the inclusion of pharmacists in the Affordable Care Act, which mentions pharmacists as part of the care team,” he said. “The Act sets out to develop and test delivery and payment models in health care, and [the PCMH model] could potentially be the first step.”

The PCMH model may prove to be a boon to patient care by driving health professionals together, even as it gives providers a cushion for absorbing the impact of health
care reform.

“It’s a holistic model,” said Setter of Washington State University. “From my perspective, that’s the way pharmacists should be practicing and the way medicine needs to move forward.”

Trygstad predicts that as physicians begin to lead multidisciplinary teams, they will see the value in such intense collaboration. The signs are already there, he said, reflecting on a conversation he recently had with a physician in a small town. “He was the sole doctor in the town” said Trygstad, adding that the doctor told him, “I’ve been practicing medicine for nearly 30 years, and it has taken me this long to realize how much I could have been learning from other professionals like pharmacists.’”

^{1. Chisholm-Burns MA, Graff Zivin JS, Lee JK, et al. US pharmacists’ effect as team members on patient care: Systematic review and meta-analyses. Medical Care. 2010;48:923–933}