A Prescription for What Ails Us?

Les Masterson, for HealthLeaders Media, April 2, 2008
In their quest to motivate chronic disease members to make healthier choices, managed care companies have added new programs and positions.

Who knew that a staple of the healthcare system might have been the answer all along?

Community pharmacists can help improve outcomes for the chronically ill, while assisting employers contain healthcare costs, and relieving physicians stretched for time. At least that's what two recent studies on diabetic patients are reporting.

Pharmacists have been taking on greater responsibilities as of late, most visibly through the Medicare Modernization Act, which offers a larger role for pharmacists through medication therapy management (MTM) services. MTM utilizes pharmacists, many of whom are certified diabetes educators, to advise patients about medication use and lifestyle issues, such as diet and exercise.

Most often thought of as the person who fills our prescriptions, reminds us of side effects, and answers our questions about cold and flu medicines, community pharmacists are an untapped resource.

The Diabetes Ten City Challenge (DTCC), which combines community pharmacist coaches with value-based insurance design (VBID), is the latest to show how pharmacists can play an additional role. Built on the successes of the Asheville Project, a pharmacist-driven diabetes program implemented in the city of Asheville, NC, the DTCC was created to test a self-management/pharmacist coaching model in multiple locations. The employer-based diabetes self-management program, run by the American Pharmacists Association (APhA) Foundation, is in 10 locations with 29 self-insured employers.

An interim report released in the March/April issue of Journal of the American Pharmacists Association reported that the DTCC decreased patient blood pressure, and A1c and cholesterol levels, improved care measures, and helped create patient self-management goals after one year.

Another recent study by the University of Oklahoma Health Sciences Center's College of Pharmacy in Oklahoma City released the findings from a nine-month study Evaluation of a Community-Based Diabetes Management Program among HMO Enrollees, which reported pharmacists helped improve patient A1c levels and move the majority of the intervention group to within the A1c level goal after only nine months. Support for pharmacists playing greater roles is backed by pharmacist advocacy groups, and managed care organizations are intrigued. Gordon Norman, MD, MBA, chair-elect of DMAA: The Care Continuum Alliance, a disease and health management organization, recently told me he thinks pharmacists and pharmacy techs could be valuable members of a health team.

A pharmacist could meet patients between physician appointments, test patients for A1c and cholesterol levels, coach patients on health issues, and create clinical, fitness, and nutritional goals. After the visits, the pharmacists could update the patients' physicians. All of this kept patients in the DTCC focused on improving their health.

There is still the question as to how to reimburse pharmacists who are performing these MTM services. Pharmacist coaches' work can mean improved outcomes and lower healthcare costs so it only makes sense to create a reimbursement structure. In the DTCC, the self-insured employers reimbursed pharmacists for patient visits depending on the fee schedules negotiated by the local pharmacy network, which self-insured employers and managed care companies would need to mirror if they expect pharmacists to take part in MTM programs.

Pharmacists are showing they can be valuable pieces in the care team. Do managed care companies make them part of the healthcare solution or do we miss out on adding a potentially valuable member to the care team?

Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com .
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