On average, patients visit their community pharmacist 12 times more often than they do their primary care provider
As we entered 2022, I asked a few health care leaders involved with the Get the Medications Right Institute to share some of their “must haves” for the rest of the year and beyond. I’m including 6 here, with the caveat that these are ongoing goals for 2022 and beyond.
Must-have 1: The patient as full participant
Patients must be recognized as full participants in the care team, and they must be involved in developing their own care plan and medication plan.
“As far as I’m concerned, the worst-case scenario is developing a care plan without active patient participation and then presenting it to the patient as a fait accompli,” said Elizabeth Helms, director of the Chronic Care Policy Alliance, and president and CEO of the California Chronic Care Coalition. But that’s exactly what’s happening in most care settings. “We’re living the worst-case scenario.”
Must have 2: Empowered clinical pharmacists in the community
Pharmacists in the community are—literally—well situated to meet the needs of the underserved, according to Michael Hochman, MD, primary care physician and CEO of Healthcare in Action, SCAN Group’s homeless initiative.
On average, patients visit their community pharmacist 12 times more often than they do their primary care provider. That makes sense once you consider that more than 90% of the US population lives within 5 miles of a community pharmacy.1
Clinical pharmacists, who are right there in the community and know the patients, represent an incredibly valuable—and incredibly underutilized—resource. He also sees an opportunity for clinical pharmacists to extend a practice’s reach beyond the walls of a practice.
“I think there does need to be a little more outreach—the clinical pharmacist going out, through collaborative practice agreements,2 and seeing patients, and helping us manage their complex needs,” he said.
This is especially the case for people without homes because they’re unlikely to visit a clinic.
“They’re much more likely to respond if you meet them in the community rather than a traditional medical office practice.”
Must have 3: Employers who push for better health plan coverage and think beyond the pill
Employers need to exercise their spending power and focus on implementing more innovative, comprehensive health plans with their medical carriers and pharmacy benefit managers. They need to look for integrated benefit designs that consider whole-person care investing in programs that impact total cost of care.
In the context of medication, that means “moving from focusing on the pill to the patient care process,” said Karen van Caulil, PhD, president and CEO of Florida Alliance for Healthcare Value. “Current approaches are largely piecemeal, failing to address the appropriate use of medications and employees have recognized that there’s a better way to address health plans and medication management within it.”
Employers need to think beyond the cost of a specific medication and consider how medications are selected, managed, and monitored, she says. Employers need a more comprehensive approach: comprehensive medication management (CMM).
We think they are ready. A recent GTMRx survey of more than 300 HR leaders found that 87% of respondents believe their company would benefit from a more innovative way to manage medication therapy problems and more than 90% say offering a medication expert and/or clinical pharmacist would be helpful in better understanding medications. And comprehensive medication management provides precisely that.
Must have 4: Improved care coordination and follow-up
This, admittedly, is a stretch goal but is nonetheless essential. For decades, care has been disconnected and fragmented. Payment silos create care delivery silos causing fragmented care with no one accountable for coordination or outcomes. Simply treating a patient, sending them on their way, and not integrating activities or information across the continuum of care is unsafe and inadequate.
“Delivering value-based health care requires thoughtful coordination and follow up, where patients are carefully managed to ensure successful attainment of treatment goals,” said Steven Chen, PharmD, associate dean for clinical affairs, School of Pharmacy and professor of clinical pharmacy at the University of Southern California School of Pharmacy.
That requires a multidisciplinary approach involving clinical pharmacists, physicians, other health care team members and patients, according to Chen. It requires “care coordination that leverages the expertise of every team member.”
And today, when 80% of the way we treat and prevent illness is through medications, most often those teams should include a clinical pharmacist.
Must have 5: Support for primary care
A recent Commonwealth Fund finds that the United States. lags far behind other wealthy countries in primary care.3 Americans are the least likely to have a regular physician, a regular place of care, or a longstanding relationship with a primary care provider.
It’s little surprise, given that only about 5% of US health care spending goes to primary care.4 And yet, primary care is the only area in health care where an increased supply is associated with better population health and more equitable outcomes.5
We’re realistic; this is another stretch goal. Adequate primary care support won’t happen by the end of the year. But what can—and must—happen this year is new investments in primary care.
One place we’re looking is the Center for Medicare and Medicaid Innovation (CMMI). Its mission is to test and implement value-based, person-centered, and team-based payment models that can support improved patient care and cost savings, which aligns with our goals at GTMRx.
CMMI can play a central role in developing payment models that allow greater access to team-based care and services that will optimize medication. Ideally, CMMI will formally incorporate payment for team-based care offering comprehensive medication management services designed to optimize medication use into Medicare.
Must have 6: Broader adoption of CMM
I’ll end with my must have—one shared by everyone I spoke with. And yes, it’s a stretch goal: optimizing medication use through comprehensive medication management in practice. It came up several times. So, what is it? It is:
The standard of care that ensures each patient’s medications (whether they are prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.6
Why medication? More than 10,000 medications are available on the market.
That’s not surprising, given that medicine is the way we treat most conditions. Roughly 75%-80% of physician office and hospital outpatient clinic visits involve medication therapy.7.8
Nearly 30% of adults take 5 or more medications.9
Unfortunately, this medication use is not optimized. As a result, more than 275,000 die each year because of non-optimized medication use. The financial cost tops $528 billion annually.10
This is why pharmacists must be part of multidisciplinary care teams.
CMM requires expertise. It isn’t merely about “the pill” or mere adherence. It’s a wholistic, comprehensive approach to health care.
“What’s important is that medication appropriateness and effectiveness was a much more common problem than the things that most people assume pharmacists deal with, such as medication adherence, polypharmacy, etc.,” Chen said. “Those are also obviously very important, but the point here is that the pharmacists are looking carefully at the appropriateness of medication use and fine-tuning treatment to help patients reach goal.”
The dual pandemics—COVID-19 and the opioid crisis—revealed the pressing need for health care groups to align around a common mission: team-based primary care delivery that treats the whole patient for better care and outcomes.
And from our perspective, that begins with getting the medications right—changing how medications are prescribed, managed, and used. That’s the biggest must-have of all.
About the Author
Katherine “Katie” Herring Capps, executive director and co-founder, GTMRx.
- Strand MA, Bratberg J, Eukel H, Hardy M, Williams C. Community Pharmacists’ Contributions to Disease Management During the COVID-19 Pandemic. [Erratum appears in Prev Chronic Dis 2020;17. http://www.cdc.gov/pcd/issues/2020/20_0317e.htm.] Prev Chronic Dis 2020;17:200317. DOI: http://dx.doi.org/10.5888/pcd17.200317external icon.
- A collaborative practice agreement creates a formal practice relationship between a pharmacist and a prescriber. CPAs specify what functions (beyond the pharmacist’s typical scope of practice) can be delegated to the pharmacist. These typically include initiating, modifying and/or discontinuing medication therapy
- FitzGerald, M, et al. Primary Care in High-Income Countries: How the US Compares (Commonwealth Fund, Mar. 2022). https://doi.org/10.26099/xz8y-3042
- Martin S, Phillips RL, Petterson S, Levin Z, Bazemore AW. Primary Care Spending in the United States, 2002-2016. JAMA Intern Med. 2020;180(7):1019–1020. doi:10.1001/jamainternmed.2020.1360
- National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. https://doi.org/10.17226/25983.
- McInnis T, Webb E, and Strand L. The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient OutcomesPatient Centered Primary Care Collaborative, June 2012
- McInnis, T. et al., editors. The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. 2nd ed., Patient-Centered Primary Care Collaborative.
- Centers for Disease Control and Prevention. “Therapeutic drug use.” https://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm.
- Medication Errors. June 2017, http://psnet.ahrq.gov/primers/primer/23/medication-errors
- Watanabe JH, McInnis T, Hirsch JD. Cost of prescribing drug-related morbidity and mortality. Ann Pharmacother 2018;52(9):829-37. https://doi.org/10.1177/1060028018765159