The rollout of the Affordable Care Act (ACA) has been for many a challenge, but Marie Smith, PharmD, says a recent stint examining policy options for new health care delivery and payment models convinced her this could be a time when pharmacists are positioned for greater roles in team-based patient care.
“The ACA affords a tremendous opportunity for pharmacists,” said Smith, Henry Palmer Professor and Assistant Dean of Practice and Public Policy Partnerships at the University of Connecticut’s School of Pharmacy. “The traditional ways of providing health care services are being challenged, and pharmacists will be seen as high-impact team members.”
Smith recently completed a 6-month faculty leave at CMS. There, as a member of CMS’s Center for Medicare & Medicaid Innovation (the Innovation Center), Smith was a senior adviser to the Innovation Center’s Comprehensive Primary Care (CPC) team. She was the only pharmacist on the team, which consisted of physicians, a physician’s assistant, nurses, and several experts in health policy, quality improvement, program evaluation, health information technology, and patient and provider engagement.
The CPC initiative is a 4-year model testing care delivery transformation in primary care practices in seven regions of the United States. CPC is a multipayer program, one in which Medicare joins with 31 distinct payers, including state Medicaid and commercial plans to transform the care delivery and payment environment for participating practices.
Working with the CPC team was a perfect fit for Smith, who has been a national thought leader and researcher of physician–pharmacist collaborations and new methods of integrating pharmacists at the point of care in primary care practices. “There are 497 primary care practices in the CPC demonstration, and 29 CPC practices indicated they had pharmacists on their health care team. However, little was known about the pharmacists’ services and level of integration with CPC teams,” Smith said. “I got in touch with the pharmacists to get their story of what they were doing. The numbers were few, but what they were doing was extraordinary. They worked closely with the clinicians in the practice, and focused on patients with high-risk medications, complex medication regimens, or insufficient response to treatment.”
Most pharmacists in the CPC initiative were affiliated with pharmacy schools, hospitals, or health systems. CPC pharmacists reported that the funding for their positions was usually shared between the CPC practice, and a university or hospital or health system. “They were accomplished pharmacist specialists—most had been providing direct patient care in ambulatory settings for 5 or more years. By working in the CPC primary care practices, the pharmacists had direct access to the patients’ medical records and were valued as clinical colleagues. They make an immediate contribution to clinical decision-making about medication selection, management, monitoring, safety, adherence, and cost-related issues. Physicians value the pharmacist’s clinical expertise, and patients see the pharmacist as a trusted member of their health team. We found physicians appreciate having a pharmacist who collaborates with them shoulder-to-shoulder in providing direct patient care.”
Smith also helped develop a CPC pharmacist integration roadmap, a document to educate physicians and medical office staff on implementing or enhancing medication management services. The roadmap emphasized the identification of patients with the greatest medication management needs and the implementation of collaborative drug management agreements between physicians and pharmacists. It was written as part of the CPC’s strategic implementation plan for 2014 through 2016.
“There are so many medication gaps that pharmacists can identify and resolve if they have access to patient medical information and are integrated into primary care or community-based health care teams—so many benefits for patients and their families if we are recognized as a full team member and can contribute at the point of clinical decision making,” Smith said.