Pharmacists key to novel coordinated care model

CMS funds Carilion Clinic program that brings together hospital, community pharmacists and primary care physicians

Patients participating in a medication management program in rural Virginia report high satisfaction rates. Several comments from patients in the program so far reference appreciation for pharmacists specifically. The project, called Improving Health for At-Risk Rural Patients (IHARP), brings together hospital pharmacists, community pharmacists, and primary care physicians to improve medication therapy and chronic disease state management for at-risk patients who receive care in patient-centered medical homes at Carilion Clinic in Virginia.

The program is being funded through a $4.1 million grant from the CMS Center for Medicare & Medicaid Innovation in the U.S. Department of Health & Human Services.`

“What’s most unique about this program is that it’s a collaboration between pharmacists and primary care physicians,” William Lee, DPh, MPA, FASCP, Pharmacy System Director at Carilion Medical Center and principal investigator on the grant project, told Pharmacy Today.

“Without a primary care physician, patients lack continuity of care, and when pharmacists are not involved, the primary care physician lacks the expertise from a medication therapy management perspective.”

Patients who are enrolled in the program must have two or more chronic conditions, such as diabetes or high cholesterol, and take four or more medications. In addition to high patient satisfaction, early data from the program indicate clinical improvements for blood pressure, average glycosylated hemoglobin (A1C), and LDL cholesterol.

Based on data from 1,879 patients enrolled from January 2013 through June 2014, the program has also resulted in cost savings of around $1,844,265 from fewer hospital admissions, fewer physician and emergency department visits, and reduced drug product costs.

Important components

The program began in 2012 and has since expanded to 22 Carilion clinics. More pharmacists have also been hired to staff those clinics.

Hospital pharmacists at Carilion often recommend patients for the program during an emergency department visit or hospital admission, or patients are told about the program from their community pharmacist or Carilion primary care provider.

While pharmacists in the Carilion system can access patient records through the Epic electronic health record system, participating community pharmacists cannot. Since it’s important for all the patient’s providers to have up-to-date information to make clinical decisions about medication management, community pharmacists are given a secure link to view the patient’s record.

Lee said pharmacists are in an important role to alert the patient’s primary care provider on medical matters as well. If they notice a patient has edema, for example, they can notify the patient’s primary care provider.

“The community pharmacist is a huge piece of this—it’s the real-world piece,” said Lee. “Patients may come into the clinic only twice a year, but they visit a community pharmacy 32 times a year.”

Challenges remain

While community pharmacists are key to the program, challenges remain with trying to involve them more actively.

“Our expectation for integrating [community pharmacists] was originally high, and we’ve had to adjust that,” Gary Matzke, PharmD, FCP, FCCP, FASN, FNAP, Associate Dean for Clinical Research and Public Policy at Virginia Commonwealth University School of Pharmacy and co–principal investigator on the project, told Today. Virginia Commonwealth University School of Pharmacy partnered with Carilion on the grant, along with Aetna Healthcare and CVS/Caremark.

Matzke said community pharmacists are constrained by time and other priorities such as filling prescriptions.

In any case, Lee said community pharmacists in the program have gained useful experience and know firsthand the benefits of stronger relationships with their patients.

Carilion plans to expand the grant program by hiring more pharmacists and installing kiosks in participating pharmacies where patients are asked to fill out a survey. Lee said this will help them measure quality and will hopefully create an infrastructure that can integrate data and link it with reimbursement. The kiosks will also serve as a tool to alert providers to any medical or medication issues with patients.