Community pharmacy to CMS: Integrate pharmacists’ services into ACOs

CVS Caremark authors publish blog post on Health Affairs website

APhA has long advocated for better integration of the Medicare Part D prescription drug benefit into accountable care organizations (ACOs) and other integrated care delivery models. Now a blog post raising some related considerations has been published on the website of Health Affairs, a leading health policy journal.

In a June 25 blog post, “Correcting the Blind Spot in Accountability: The Role of Primary Care,” William Shrank, MD, MSHS, and three colleagues—all from CVS Caremark—highlighted “the absence of direct incentives encouraging participation of Part D plans and pharmacists, present[ed] the rationale for the important role of pharmacy in payment reform, offer[ed] innovative approaches that Part D plans and [community] pharmacies have implemented in the marketplace, and discuss[ed] further opportunities and directions.”

The authors focused on integration of pharmacists’ services in the community sector, and noted that community pharmacies have developed strategies to participate in ACOs.

As payment reforms are under way in the U.S. health care system, “ACOs and other new payment models do not include the cost of pharmacy services in their measurement of total cost of care,” explained Shrank and colleagues. “The path to coordination of Part D with ACOs was not immediately clear when the ACO program was initiated.”

The authors continued that pharmacies and pharmacists lack a straightforward way of being “rewarded for the value they bring to chronic disease management. Pharmacists are not recognized by Medicare with ‘provider status,’ limiting their opportunity for reimbursement for any services they deliver to patients.”

In March 1, 2014, comments to CMS’s Center for Medicare & Medicaid Innovation (CMMI), the Association continued to call for better coordination of pharmacists’ patient care services with the clinical services of other health professionals on the patient’s health care team.

“APhA strongly believes that better integration of the Part D prescription drug benefit, especially medication therapy management services (“MTM”), into ACOs is necessary to achieve the goal of improved outcomes and efficiency,” wrote APhA Executive Vice President and CEO Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, in the Association’s comments. “Better integration of MTM services, and the pharmacists who provide them, with the rest of the health care team would help align clinical goals for the patient, better coordinate the care provided, avoid confusion, and ultimately contribute to more efficient and effective care.”

The Association concluded, “There are currently a number of barriers, including payment, HIT [health information technology] and EHR [electronic health records] access, and provider status, to effective integration of pharmacists in ACOs. As CMMI continues to explore new ACO initiatives, we hope you will use APhA as a resource.”


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