‘The door is wide open,’ Isetts says of time at CMS Innovation Center

Pharmacists partner with CMS



Isetts

For Brian Isetts, BSPharm, PhD, BCPS, FAPhA, Professor of Pharmaceutical Care and Health Systems at the University of Minnesota College of Pharmacy, the July 2011 invitation from CMS came as a welcome surprise. 

On sabbatical leave from his scholarly duties, Isetts had just completed a 6-month health policy fellowship at CMS, working with colleagues to evaluate the effectiveness of medication therapy management (MTM) in the Medicare Drug Benefit and C & D Data Group.

Now he was being asked to extend his fellowship for 6 months and join the action at the CMS Center for Medicare & Medicaid Innovation (Innovation Center), where exciting new models for improving quality and reducing costs of care were being developed under the Affordable Care Act.

Isetts was eager to accept. “I always had my eye on the CMS Innovation Center,” he said. “Don Berwick [the former administrator] was doing an amazing job in turning around the culture of the organization. And folks there were telling me that medication management was really going to be important to achieving programmatic aims.”  So, after obtaining bridge funding from APhA and the American Association of Colleges of Pharmacy, Isetts accepted the offer to stay for 6 additional months. In January 2012, that second tour would be extended again for 2 more years.

Medicare Part D MTM

Isetts had already witnessed what the collaboration of pharmacists could achieve during his initial 6 months at the agency, where he helped to create a standardized format for the Medicare Part D MTM Program. In 2003, when the prescription drug program for Medicare beneficiaries was first created, he said, “it had very few guidelines that let the market decide what the service would be.”

The standardized format would help to correct that. It meant, Isetts said, that when Medicare beneficiaries received the annual comprehensive medication review required under the law, they would be given a standard summary of the encounter, including a medication action plan and complete medication list.

 “What was important about that,” Isetts said, “was that it was the first step in providing a consistent and standardized patient care process for beneficiaries—something that we need to pay close attention to in the profession of pharmacy.”

Partnership for Patients

Then, at the CMS Innovation Center, Isetts worked on a bold public–private initiative called the Partnership for Patients. Its 3-year goal was to reduce hospital-acquired conditions by 40% and all-cause readmissions by 20%, compared with 2010. The program, covering 26 hospital networks with a total of 3,700 hospitals nationwide, is set to run through December of this year. Although the final outcomes won’t be available until 2015, Isetts said interim results announced in a May 7 CMS news release have indicated that “substantial” progress is being made, including a significant reduction in adverse drug events. 

That effort to reduce hospital-acquired conditions and patient readmissions was just part of the pioneering work—including improving transitions of care and reducing health care risks—that Isetts was part of at the CMS Innovation Center. “All of these pieces really needed the critical input of pharmacists contributing on interprofessional health care teams,” Isetts said.

“One of the values that Dr. Berwick brought that endures,” he said, ”is this high premium on collaboration between government and our partners across the provider, payer, and patient engagement communities. Today we can talk about CMS being a trusted partner in redesigning health care delivery and financing. That would have been a pipe dream 5 years ago.”

Importance of pharmacists

Pharmacists are an important part of that partnership, he said. They are “helping CMS understand what is important, and CMS is helping pharmacists understand what is important to our national aims of improved health and better care for populations at reduced per-capita expenditures.”

But he also noted that “pharmacists are seeking payment for what we do. To do that, we have the benefit of all the outcome studies that have been done over the past 20 years. What will happen as we go forward is that those outcome studies will contribute to redesigning a future health care delivery system that is built on outcomes-based or value-based reimbursement.”

“So what pharmacists need to do more is being on health care teams taking care of patients,” Isetts said. “At this point, we’re not getting paid as well as we’d like to, or as much as we’d like, but the needle is moving in the right direction. So we have to continue to demonstrate our value because the door is wide open.”