Expanding pharmacy’s role in value-based care

Tony Willoughby: ©Stellus RX

People would be healthier if they took their medications as prescribed. Fundamentally, we all know this. Outcomes would improve. Quality of life and lifespans would increase. Total health care costs would recede, because healthier people require less health care services.

Physicians and their teams could spend more time working with their patients on the next steps in their health, rather than feeling mired in the same challenges. Their ability to deliver delight in the patient journey would improve. Their performance and success in value-based care models would leap forward.

The paradox: If we have unwavering belief that improved medication adherence can unlock healthier lives for patients, as well as greater impact and financial performance for physicians, why does it remain such a dramatically under-resourced and disjointed function of health care delivery?

All too often, patients receive life-changing news about their health—new conditions, new medications, new complexity to manage. Their prescriptions are sent off to be filled; maybe the patients receive some educational information. But then what?

In these moments, patients face decisions about whether to fill their prescriptions, whether they can afford their medications, whether new medications will conflict with existing medications.
And in all these situations, with so much at stake and no easy answers, the typical health care system gives them no clear access to trusted answers. In these moments when patients often need the most help, they often feel the most alone.

Physicians and their staff can’t be the only resources for expertise and direction. They are already overwhelmed and overburdened. As much as they’d surely want to, they simply don’t have the bandwidth to follow-up with patients throughout their medication journeys.

What if pharmacist-led teams could step in to help?

On the face of it, the idea seems like a non-starter. Physicians and their staff are stretched too thin to provide medication support; surely pharmacists feel the same degree of burnout. Our individual experiences in retail pharmacies would seem to validate that, along with mountains of data.

But if we step back from a fixed view of “what is” and instead ask “what if” then the idea of pharmacists aligned with physicians to support patients’ entire medication journeys becomes more than an interesting possibility. It becomes a no-brainer that, frankly, seems like something that should have existed at-scale all along.
Consider how many pharmacists enter the profession and stay in the profession because they want to help people. In a recent Drug Topics article that captured a host of pharmacist voices, consistent themes of dedication and excitement over patient impact rang through.

Said one pharmacist from Michigan: “What keeps me going is the ability to understand health at a much deeper level and translating it to my patients. Seeing them healthier and happier drives my passion.”

And another from Illinois: “Just hearing my patients’ stories of all the obstacles they’ve overcome, I’m honored that they entrust their medical care to myself and my team.”

This is a profession filled with purpose-driven people who want to direct their careers toward supporting patient health. More than that, it’s a profession filled with people who bring expertise that’s complementary to (but differentiated from) what physicians and other clinicians possess.

Pharmacists spend their careers demonstrating deep knowledge of a vast array of medications -- what the medications do, how they interact with one another, what patients could experience while taking them, how daily activities or diet might affect the medication experience, how much they cost for patients and what can be done to lower that cost, why certain medications might work better for some patients than others, the list goes on and on. And each point on that list could be crucial to a patient’s daily decision to continue taking their medication as prescribed or slipping into non-adherence.

Clearly, incorporating that knowledge as a standard practice for physician-led care delivery would yield immediate and enduring results. We already see a version of this model deployed to great effect in the health system setting. Health system pharmacists participate in daily medical rounds, where they regularly impact patient assessments and prescribing decisions. In a 2016 study published in the International Journal of Clinical Pharmacy, researchers observed a 78% reduction in medication-related problems as a result of pharmacist intervention.

What could a functional model look like?

1. Physicians would have access to trusted, expert pharmacists for on-demand consults about patient-specific needs. Artificial intelligence and clinical decision support solutions have shown rapid advancement, but there are multitudes of reasons why patients are still treated by real, human physicians and clinicians. The personal and nuanced dynamics of patient care demand it. The same is true with pharmacist-directed guidance, where physicians have an experienced, clinical sounding board for the prescribing decisions that can propel or arrest patients’ health progress from the moment the prescription is submitted.
2. Patients would have peace of mind at the start of their medication journey. Too often, people look to pharmacists as the last checkpoint they must pass on their road to receiving their medications. Instead, pharmacists can serve as boosters to success in that moment—proactively providing disease state education and medication guidance, working to reduce or remove cost barriers that might impact patients’ ability to fill and refill their prescriptions, ensuring that patients understand what to expect and that patients feel understood about any anxieties they might have about what lies ahead.
3. Patients would have the answers they need for their health.
Between physician appointments—when it’s just patients on their own with their medications—trusted pharmacists would connect regularly with their patients to serve as equal parts accountability partner and support. That might mean helping patients make adjustments to their daily activities and diets to accommodate their medications better. It might mean encouraging them to track their health metrics more consistently (like glucose monitoring for diabetic patients). It might mean making sure their medications are packaged in ways that reduce complexity and confusion about when and how to take them.
4. Physicians and pharmacists would have aligned incentives for outcomes.Financial models for pharmacies today create far too much emphasis on medication dispensing as the dominant financial lever. As a result, pharmacists in traditional retail settings must focus disproportionate time on dispensing operations; their identity as clinicians becomes superseded by their identity as operations leaders. To elevate pharmacists’ clinical expertise and unlock the time they can spend on patient engagement, businesses must reimagine the physician-pharmacist relationship. The expansion of risk-based care models—with pharmacist-led medication support and adherence targets included as components of physician-directed care delivery—is one clear pathway toward this.

The catalyst for all of this will be for physicians and pharmacists—two of the most overburdened professional segments—to lean on one another in more substantive, persistent and consistently collaborative ways. When physicians and pharmacists can deliver integrated, supportive care experiences that extend throughout the entirety of each patient’s health journey, we’ll see force multiplying effects that will materially affect patient outcomes, experience and costs—all while relieving burden for all.

Tony Willoughby, PharmD, is CEO and Cofounder of Stellus Rx, a national provider of pharmacist-led medication support solutions that help people get the most benefit and value from prescribed medications. With a career in pharmacy and health care that has spanned 20+ years and included executive roles with Target, McKesson and Catalyst Health Group, Tony has demonstrated passion and expertise for building services that help people make the best and most sustainable decisions for their health.