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As we race to prepare providers and the health care systems and infrastructure to implement COVID-19 vaccinations, we must consider the pharmacy’s principal role in improving care quality. Beyond immunization adherence, pharmacists at all levels—in clinical and care management roles, retail and community pharmacies and pharmaceutical companies—have evolved from focusing on transactional business models to providing expertise and resources in quality improvement. Many are part of vertically integrated models and are positioned to play a meaningful role in implementing quality-based care programs.
How can health care stakeholders such as providers and payers better leverage pharmacies to drive quality improvement?
Pharmacy Care Management
Pharmacy care management enables patients to receive medication consultation immediately upon authorization—patients understand the prescribed therapy before they take the first dose. The pharmacist can immediately evaluate whether a drug conforms to the patient’s medical needs and can educate and follow the patient through each step of the care timeline.
Pharmacists can also focus on improving these crucial quality areas:
- Medication adherence.
- Medication therapy management.
- Medication reconciliation.
- Medication synchronization.
- Medications (transition of care and “gap care”).
Pharmacy-based disease state management
· Chronic diseases:
· Outpatient pharmacist-based clinics:
- Discharge planning.
- Formulary compliance.
- Performing prior authorization to ensure that dispensing of costly medications is medically necessary.
Payers recognize that community pharmacists are experts when it comes to managing proper medication use and patient adherence. Retail-medical clinics are a touchpoint to address clinical and social barriers in the community. The industry has focused on five quality measures where pharmacy can have the most impact:
- Treatment of hypertension in diabetic patients with an RAS antagonist.
- RAS antagonist adherence in the treatment of chronic hypertension (non-diabetic patients).
- Statin adherence in the treatment of hyperlipidemia.
- Oral diabetic agent adherence in the treatment of diabetes.
- High-risk medication use in the elderly.
Value-based care has real potential to bring value to pharmaceutical companies, payers, patients and providers in advanced health systems, delivering resources to critical therapeutic areas like oncology and cardiovascular.
Pharmaceutical companies invest in models to collaborate with payers and providers in joint-value initiatives. This offers unbranded resources and platforms to address meaningful quality improvement strategies, such as developing joint models to measure and address potentially preventable hospitalization and improving quality measures.
Quality performance measure categories where pharmaceutical companies can play a significant role include:
· Risk sharing and expertise-based partnerships focused on:
- Medication adherence, safety and therapy management.
- Joint evidence generation.
- Data analysis.
- Resource enablement, including utilization, disease management, quality and social determinants of care.
The urgent demand to administer vaccines in the coming months, coupled with the need to improve quality and health equity at the same time, facilitates the opportunity to place pharmacy as an integral part of care pathways. But this can happen only if stakeholders define and measure outcomes effectively, choose appropriate patients and manage costs efficiently.
2. What opportunities has your organization identified, in collaboration with pharmacies, to implement or advance a reminder-recall system or report to an immunization registry?
3. What clinical or operational challenges should health care stakeholders consider when integrating pharmacy into their population health management model?
Vanessa Guzman,CEO,SmartRise Health
Vanessa Guzman is an expert in population health strategies, including patient and physician engagement strategies, clinical reporting, health IT and quality management models, and CEO at SmartRise Health. With almost 15 years of industry experience, she works closely with health systems, Accountable Care Organizations (ACOs), technology, and SDOH partners to collaborate in implementing data-driven tools, clinical infrastructures, and community partnerships to promote wellness and improve patient health outcomes.
Vanessa served as the Associate Vice President at the Montefiore Health System, a top-performing ACO in the country, overseeing physician partnerships, population health and quality improvement, and health information technology.