HealthPartners uses clinical pharmacists in an educational and counseling role to support care team efforts to enhance outcomes, reduce costs, and improve patient engagement.
When Medicare Part D went into effect in 2006, HealthPartners—a Bloomington, MN–based integrated health system with seven hospitals, 27 primary care clinics in Minneapolis and St. Paul, and a health plan that covers about 1.5 million members—started a medication therapy management program to assist seniors with maintaining their prescriptions.
Pharmacists conduct assessments to ensure that Medicare patients understand why and how to take their medications, that they are taking all medications as prescribed, and that the medications are safe and effective. Patients are also evaluated to be sure that their expectations are realistic about their drug therapy and that any concerns they have are addressed.
"We hired clinical pharmacists who don't have dispensing responsibilities, and we've seen a significant ROI for people who receive this service versus those who don't, especially in the form of decreased hospitalizations and ED visits," says Richard Bruzek, HealthPartners' vice president of pharmacy services.
Both from a clinical and financial standpoint, the results of the MTM program are, indeed, substantial. A five-year study found that 60% of patients with diabetes who participated in the MTM program maintained optimal control over their disease versus 40% of patients receiving standard care. Additionally, a 2008-2009 analysis showed that the total cost of care for patients in the MTM program was 19% lower than for patients who were not.
The MTM program was also successful in helping patients with hypertension reduce their blood pressure. In an 18-month clinical trial of 450 adults, 72% of patients who received MTM and telemonitoring services were able to get their blood pressure to recommended levels versus 57% of patients in the control group.
Enhancing the "Role of the Pharmacist"
Spurred by these successes, HealthPartners launched its "Role of the Pharmacist" campaign about three years ago to begin using its pharmacists more effectively for all its patients and health plan members.
"One of our goals has always been to utilize pharmacists in our clinics and in the community at the top of their license," Bruzek says, noting that in 1999, HealthPartners centralized its pharmacy order fulfillment services to one location. Prescription refills are done at this site whenever possible and then shipped to clinics three times per day.
"This frees our pharmacists up at the clinics to spend more time with patients. We can get more value from our pharmacists if they aren't spending their days counting, licking, and sticking," Bruzek says. "Pharmacies are busy places, and if those prescriptions are filled at the center, pharmacists can use their time counseling patients."
To maximize the time spent with patients, HealthPartners gave pharmacists specialized training to improve their ability to interview patients and to use the electronic health system to do charting, Bruzek says. The initial focus has been on patients with diabetes.
"Now, any patient with diabetes who comes into the clinic's pharmacy receives extra services," he says. "Pharmacists can look at the EHR to see if patients are on track for scheduled appointments, labs, medication refills. The pharmacists look at their total profile to reinforce treatment goals and check lipid levels, blood pressure, and all the things we are trying to get diabetic patients to be better at. If a patient has missed an appointment with their primary care physician, the pharmacist can also schedule them for another appointment."
Building a population health model
Having pharmacists be a bigger part of the primary care delivery model will be increasingly important as the healthcare industry shifts to value-based reimbursement models, Bruzek says.
"It's definitely a move toward population health management. People see the pharmacist more than any other provider, so … the pharmacist can reinforce the care plan and start to make real gains in patient engagement."
Overall, physicians are responding well to the pharmacists' increased role in providing medication maintenance counseling to patients, Bruzek adds.
"They feel, for the most part, that they have enough to do and that any assistance they can have with helping their patients have better outcomes is appreciated, particularly with all the quality measures that everyone is subject to."
Since launching the new initiative, HealthPartners' pharmacists have had 18,000 encounters with diabetic patients, and while the organization has yet to analyze the impact on patient outcomes, Bruzek says the initial feedback from its pharmacists has been positive.
"The pharmacists were scared to take on this new role at the beginning, but now they say it's the greatest thing for patient care. … We've heard a lot of anecdotal stories, and we are going to start looking at the hard numbers now."
Expanding disease states, lowering total cost of care
HealthPartners is also growing the program this month to include patients with hypertension, and has plans to do the same for patients with chronic pulmonary obstructive disease in the near future.
"These are all very important disease states that are quite prevalent. We did a study of patients with hypertension and one-third of people who took their medications as prescribed still did not have their blood pressure under control. If they are coming into the clinic for a refill, the pharmacist can do more for them. For example, they can check their blood pressure regularly versus once a year in the physician's office," Bruzek says.
As the Patient Protection and Affordable Care Act puts pressure on healthcare providers to reduce the cost of care, using pharmacists to a greater capacity will only become more important, he adds.
"Those health systems that have this type of pharmacy support will be more successful in meeting their objectives around the total cost of care than those hospitals that don't."