Community pharmacists at Moose Pharmacies keep high-risk patients out of the hospital

Adherence programs can save money for third-party payers

Pharmacists at Moose Pharmacies, an independent drug store chain in the Piedmont region of North Carolina, have visited hundreds, if not thousands, of patients’ homes as part of a drug adherence program they offer in the community.

“Out of all the home visits that we’ve done, we have not found a single patient yet whose doctor’s med list matched up with what the patient was actually taking,” said Joe Moose, PharmD. “You would think that you would get one patient who is doing it right, but we haven’t gotten one yet.”

Through the adherence program, pharmacists from Moose Pharmacies make house calls to perform medication reconciliations for recently discharged patients or patients who are at high-risk for nonadherence. Moose Pharmacies offers this program to all patient groups. One of the groups with whom they work, Community Care of North Carolina, has demonstrated that a team-based approach conducting in-home interventions, and other face-to-face pharmacist interventions, can reduce inpatient admissions by up to 46.8% and reduce preventable admissions by 35.4%, according to a 2013 study in Health Affairs.

Regardless of how much money adherence programs like this one can save third-party payers, pharmacies don’t typically share in those savings. This makes the programs unsustainable for the key players that run them. While many patients and health care providers recognize the value of services like those that Moose Pharmacies provides, pharmacists cannot bill for such services because payers do not recognize them as health care providers. Moose, like the other pharmacists profiled in this series, does not have “provider status.” This is the qualification that allows physicians, nurses, physician assistants, physical therapists, and most other health professionals to bill insurance for patient care.

“The health care system is missing the value of the pharmacist, who is probably the most underutilized health care provider out there,” Moose said. He points out that these complex patients see their pharmacist almost three times every month, compared with two annual physician visits, but they don’t get as much value out of these frequent encounters as they could.

Moose wishes he could take the time to reinforce the patient care plans that their physicians lay out for them during each of these visits. But until pharmacists can be reimbursed for such services, he can’t take the time away from the activities that pay his salary: filling prescriptions.

“The adherence program was covered by the reimbursement we got for the drugs we dispensed, but as that reimbursement dwindles and goes away, it’s just not economically viable for us to continue without an external pay source,” Moose said, referring to the advent of preferred networks that cut reimbursements to pharmacies on prescription drugs for Part D patients.

Moose says he and his colleagues will continue to do face-to-face interventions with patients for as long as they can afford to unless they can arrange a means of reimbursement for their services. The independent pharmacy chain is exploring the possibility of contracting with third-party payers in the state in order to provide medication management to their members for a monthly fee per beneficiary.

Provider status, however, could preclude pharmacists from hustling to get contracts with individual payers. Pharmacists would be able to identify patient problems, such as misunderstanding how to take critical medications, and intervene to solve the problem. Then they would bill for their services, just like any other health care provider.

“There is a several-month gap between primary care visits, and we’re the health care provider seeing them during that time,” Moose said. “We can provide that continuity of care, and bridge those gaps—but the current payment mechanism doesn’t allow for that.”