Broad adoption of value-based payment models in primary care creates the potential for a seismic shift in health outcomes, patient and provider experience and reduction of total cost of care. But physicians can’t bear the burden of care delivery and patient support on their own—nor can physicians trust just any third-party organization to produce a continuity of care that’s aligned with their specific requirements and expectations. A generational opportunity to transform healthcare has produced a set of new quandaries to solve. Perhaps we just haven’t looked in the right place for answers.
Consider the often-stated and ever-alarming statistics that give just a thumbnail sketch of the challenges in US healthcare today …
Across the board, costs continue to rise, with total costs expected to surpass $6.8 trillion by 2030. Patient access to care will continue to feel constrained, with a nationwide shortage of up to 124,000 physicians expected by 2034. Our population of people over the age of 65 continues to grow—and live longer—but also with a greater prevalence of chronic conditions.
It might surprise you then to hear that we’re on the verge of transforming healthcare for the better … if only we can accelerate and more effectively support the broad adoption of value-based care models. Right now, we face a pivotal moment in the march from traditional fee-for-service healthcare to value-based models that align financial incentives for all with improved patient outcomes, healthier patients and overall reduction of costs. More than 65 million insured Americans—or one in five people—will be covered by a value-based plan by 2025. Medicare Advantage enrollees comprise a large and growing part of that number, with projections indicating that Medicare Advantage will become the dominant way people receive their Medicare benefits by 2025. These are all moves in the right direction for healthcare providers and stakeholders who seek a healthcare environment that enables personalized attention for patients, as well as time and focus to devote to keeping patients healthy and not just treating them when they are ill.
At the same time, an already-overburdened population of physicians and providers cry out: Where will the help come from? Who can support patients and address their host of needs between the time the patients see their physicians and providers? And who can do that work in a way that extends the care provided by physicians, rather than just adding another layer of complexity? One idea which has, in recent history, been vastly undervalued and overlooked … pharmacists.
Turning again to the clear-cut numbers, patient nonadherence to prescribed medication costs the United States upward of $300 billion a year in avoidable expenses. Worse yet, nonadherence to medication is directly correlated to 125,000 patient deaths per year. Why wouldn’t we want pharmacists—the closest and most-often-interacted-with and most-accessible clinical resource for patients and their medications—to be more deeply engaged in patients’ medication regimens and addressing the barriers that prevent healthier behaviors? Physicians and their staff often do not have the bandwidth to address all the components of care delivery in today’s mix of fee-for-service and value-based care. As the proportion shifts to value-based care—where physician performance is evaluated even more on health metrics that connect naturally to chronic condition management and medication adherence—it only makes sense for pharmacists to play a greater, more integrated role in patient care and health success.
Imagine all the moments that matter in patient health, where pharmacist intervention could change patients’ outlook, mindset, actions and enduring behavior … moments like new diagnoses and new medications, unexpected side effects, cost or logistics barriers to accessing medications, interactions with other medications or dietary impact, confusing or conflicting medication regimes. The list goes on, and each individual part is so crucial in achieving optimal results.
The key to unlocking pharmacists’ impact lies in uncoupling pharmacists from pharmacy counters, both physically and conceptually. Rather than focusing the bulk of their daily time and effort on directing dispensing operations (as most pharmacists do in traditional retail settings), pharmacists are discovering the outsized impact they can have as connected members of care teams in value-based care models. Here, they use and deploy a blend of high-tech and high touch to identify patients at the right moments and work collaboratively to explore and remove the main barriers to medication adherence and improved health.
Often these barriers sit below the surface of “standard” healthcare conversations and would otherwise go unseen, and thus, unaddressed. For example, a pharmacist at our organization took time to talk with a patient about her diabetes medication regimen and discovered the patient was also practicing intermittent fasting for weight loss, which reduced medication effectiveness. By building trust with the patient and educating her about how fasting changed the way her medications worked, the pharmacist worked with the patient to reduce her A1C by 66% in five months. What did we see there? Improved health for the patient, a more supported care experience without additional intervention required from the patient’s physician, and value created by the pharmacist’s willingness to listen and educate in a relationship-driven way. Perhaps even more importantly, we see a patient who gained an understanding of how significantly her own choices—even small choices—could positively impact her health.
The beauty of the pharmacist-led patient engagement model described is that it exists today. Even as value-based care finds its footing and expands further, team-based approaches to care delivery incorporating pharmacists as crucial connections are already bearing results—helping provider organizations achieve 5-star CMS ratings for medication adherence, driving down costs, and driving up the quality of life for patients. Shared risk agreements for pharmacist-led support services create even greater alignment in value creation. So, as it turns out, the question isn’t why pharmacists … or how … or even when. The real question must be: When will we see more?
Photo: Ridofranz, Getty Images