Innovative health services in rural America

Health center uses 340B Drug Pricing Program to bring team-based care to underserved patients

Donavan Smith, BSPharm, Director of Pharmacy Services at Wayne Community Health Center, describes the necessary drug therapy and regimen to a patient recovering from a cardioversion.

In early 2010, with his heart feeling “out of rhythm,” a 58-year-old male drove 40 miles to the Wayne Community Health Center (WCHC) in Bicknell, UT. As an owner of a small gourmet bread business, he struggled to make ends meet and lacked health insurance. His income placed him below 200% of the federal poverty level. He had seen a cardiologist in the past and had been trying unsuccessfully to save enough money for a cardiac ablation, a technique used to treat abnormal heart rhythms such as his atrial fibrillation.

After receiving an electrocardiogram at WCHC, the patient learned that he had experienced a recurrent episode of atrial fibrillation. Because the patient drove to WCHC, a facility enrolled in the 340B Drug Pricing Program, he received the care he needed right away, instead of having to save enough money to pay for the procedure. The 340B program, which requires drug manufacturers to provide outpatient drugs to eligible health care centers, clinics, and hospitals at a reduced price, enabled the patient to leave the center after paying just $25 for the specialized care.

Providing essential care

WCHC is a leading practice site and a model of excellence for transforming health care where no patient is denied services due to his or her inability to pay. The center stands as a bulwark against some of its clients’ greatest fears, such as the inability to pay for necessary medical services and isolation in times of emergency.

According to the 2013 United States Census, Utah’s Wayne County has roughly 2,700 residents, 45% of whom are below the poverty level. Additionally, almost a quarter of the population has no health insurance. Without WCHC, residents would have to travel between 57 and 113 miles for the next closest health care provider, making chronic health care issues nearly impossible to manage.

Today, almost 4,000 patients take advantage of this rural medical facility that provides essential services to the community. These services include primary health care, emergency care, diagnostic tests, preventive health care, dental care, pharmacy, and mental health assistance. Capitalizing on its multidisciplinary approach to treating patients, WCHC is fulfilling its mission of providing high quality health services.

A team approach

Donavan Smith, BSPharm, Director of Pharmacy Services at WCHC, is most proud of the “full-on team” approach for treating patients. “If a patient comes in for teeth cleaning, they get their blood pressure checked. If their blood pressure is high, then they get referred to the physician. If the physician sees that the patient has a multiple medication issue, then they come to me,” Smith explained. This interdependent model between providers allows for optimal care and transformative patient services.

As the facility’s pharmacist, Smith is an integral part of the team approach. He incorporates leading services ranging from medication therapy management (MTM) to reviews of medications for safety and effectiveness. Smith also works with the WCHC primary care provider to offer patients individualized drug therapy. The opportunity for a pharmacist to interact and have input into medication usage and patient education has proven to be very effective in improving the outcome of the facility’s services. In fact, physicians routinely ask Smith for his help.

Significant patient benefits

WCHC closely tracks the impact of legislation and the effects of existing laws on patients, health care providers, and the center. The resources from 340B program have yielded significant benefits for patients.

For example, the facility started a heart attack prevention program 5 years ago under the leadership of Medical Director L. Jeffery Chappell, MD, and Smith. The 340B program enabled the center to carry anticoagulant drugs, which are usually very expensive to stock. The availability of these discounted medications nearby provided patients with the thrombolytic medications needed to save their lives, and all of the individuals that needed this medication are alive and living a normal life.

“Our team approach, which includes both medical and pharmacy in treating patients, provided a higher level of care than we could individually,” said Smith.

Smith is always looking to enhance outcomes at WCHC. He recognized that patients were having difficulty understanding the purpose of their medications, possibly contributing to taking excessive or insufficient amounts of their prescriptions.

Looking to simplify the process, he started a program for labeling prescription bottles with a boldfaced word printed on the front of the bottle describing the purpose of the medicine. For example, a bottle may display the word “diabetes,” “cholesterol,” or “supplements.” Not only did this program reduce injuries, it also fostered better collaborations between the patients and staff. The reliance on pharmacists as part of an interwoven team of providers achieves a higher level of care for patients at WCHC.

Proof of quality

As with most government initiatives, the 340B program has its critics. Last month, Smith offered a presentation to a congressional working group on the 340B program detailing his strong evidence-based support for the many lives saved by this legislation. Smith noted that WCHC operates at the highest level of integrity and achieves what the program was designed to do, which is to “stretch federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.”

Receiving $550,000 in federal dollars and approximately $400,000 in 340B savings, WCHC is able to provide medical, dental, and pharmacy services valued at more than $1.1 million to its patients. The ability to obtain pharmaceuticals below the normal purchasing prices allows the facility to reinvest resources for the care of those that cannot pay, and most importantly, saves the lives of patients by providing them with much-needed medicine.

By providing greatly reduced lifesaving drugs as part of an overall integrated patient health care program, WCHC continues to be a great asset to the 340B community. The program’s purpose is to help facilities provide treatment to patients who do not have the means to pay for their health needs. WCHC is able to provide optimal care due to the lower acquisition cost through the federal program.

It is with great pride that that APhA, along with the HRSA Office of Pharmacy Affairs, selected WCHC in 2012 as a HRSA 340B Peer-to-Peer Leading Practice Site that will continue to demonstrate best practices and help other organizations become high performers.