Patient Models
Lauren Howell, PharmD
This is part two of a three-part series on nancial reimbursement for pharmacists.
A health system in Pennsylvania found that integrating clinical pharmacist resources systemwide improved clinical, operational, and financial outcomes. The evidence accumulated over the more than 25 years that Geisinger Health System has provided clinical pharmacy services supports the expanded roles of pharmacists, and reimbursement for those services.
“As we work with each other and link arms to make care easier for our members and patients, the ultimate outcome is improved finances, whether that is in actual hard dollars or better outcomes,” said Adrienne Zook, PharmD. Zook is the manager of ambulatory clinical programs at Geisinger and spoke about their model during a May 2025 presentation at Innovations in Pharmacy Training and Practice to Advance Patient Care: A Workshop.
Improved outcomes
Defining, tracking, and publishing clinical, operational, and financial impacts is the key to future growth for pharmacists, explained Zook. The Geisinger program has seen a 9% to 12% total per member per month reduction in the first year of services for patients with diabetes managed by the medication therapy disease management (MTDM) program. There has also been a greater than $100,000 reduction in overall insulin costs.
Finances aren’t the only area where Geisinger has seen improved outcomes though. The health system has improved from a 3- to 5-star CMS rating by internalizing their comprehensive medication review program. Clinical outcomes have improved, too. When patients enrolled in the MTDM program with an A1C of greater than9%, they saw an average 2.3-point reduction after 24 months. Additionally, there was a 35% reduction in opioid usage and 54% reduction in patients on the high-risk combination of an opioid and benzodiazepine after 12 months of program enrollment.
Expanded roles
Geisinger has split their ambulatory clinical pharmacy programs into three different expanded roles for their pharmacists: MTDM primary care, MTDM specialty care, and nontraditional MTDM.
“We really try to focus on moving care closer to our patients and making care easier for our members to access,” said Zook. “Pharmacists really serve a critical role in being able to provide that opportunity, offering care at home and leveraging platforms such as technology for medicine.”
The MTDM primary care pharmacists focus on comprehensive, high-value, high-touch, longitudinal disease management. There are around 40 pharmacists, spread across 34 practice sites providing these services, which include MTDM for anticoagulation, diabetes, hypertension, hyperlipidemia, chronic pain, migraine, COPD and asthma, smoking cessation, and HIV oral PrEP.
Geisinger’s MTDM specialty care pharmacists provide high-value, low/moderate touch, highly specialized interventions. These services include rheumatology, gastroenterology, neurology, cardiology, endocrinology, dermatology, pulmonology, hepatology, and nephrology. They currently have 29 pharmacists across 24 practice sites, each with 350 to 500 active patients.
The nontraditional MTDM pharmacists provide comprehensive, high-value, high-touch services that are a hybrid of specialized interventions and disease management. As part of these services, which are aimed at patients older than 65 years, around 775 total medication reconciliations are completed for each month by 18 pharmacists and four pharmacy technicians who are integrated into 17 practice sites.
Looking forward
Zook believes that moving forward, pharmacy programs should work on optimizing revenue generating opportunities without losing focus on patient outcomes. She recommends pursuing opportunities for value-based agreements or payer partnerships, implementing efficient programs by optimizing technology and targeting the right patients, and advocating at a state and federal level for provider status and enhanced reimbursement. ■