All About Work of Pharmacists in Value-Based Care

Evidence of the successful integration of pharmacists into Value-Based Care, PCTs, and Alternative Payment Models (APMs) can be found in several sources. This article will discuss the work of pharmacists in these settings and how the profession can play a role. Here is a quick overview of the most recent evidence in the work of integrating pharmacists into value-based care. The evidence summarizes the work of pharmacists in various health systems.

Evidence of successful integration of pharmacists into value-based care

Increasingly, organizations recognize the value of pharmacists in health care. A recent report identifies two ways pharmacists can improve patient care: by improving patient safety and quality metrics. Pharmacists in a Patient-Centered Medical Home are integral members of the care team. These integrated practices have reduced the number of patient admissions, amputations, and emergency department visits. Pharmacists’ access to electronic health records (EHR) is essential for high-quality care.

The integration of pharmacists into value-based care involves a defined reporting structure, standardized philosophies of practice, and formal credentialing processes. In addition, pharmacists must be directly involved in quality improvement activities, such as leading calls to patients to check adherence to treatment plans. A quality improvement program may include a standardized interview guide that identifies discrete data elements that indicate the pharmacist’s contribution to patient care.

The study includes organizations at varying stages of the implementation of value-based care. While the payment model had value-based payments, pharmacists must also receive FFS reimbursement. Therefore, pharmacists need a mix of FFS opportunities and value-based incentives to be successful. The study also identifies five factors that help pharmacists create value in value-based care. These factors are relevant for other primary care pharmacists and practices implementing value-based pharmacy practices.

Evidence of successful integration of pharmacists into PCTs

The integration of pharmacists into PCTs has improved the quality of primary care services, increased patient satisfaction, and reduced medication costs, according to recent research. Despite the challenges, this model is gaining support for implementation in primary care across Canada. However, further research is required to identify the specific impact on the health system. In the meantime, the role of pharmacists in PCTs continues to expand.

High-level pharmacy engagement and collaboration are critical for the success of value-based plans. However, the pharmacy workforce lacks the necessary recognition to demonstrate patient value. For this reason, pharmacists often serve as secondary providers or in referral roles to other teams, and they may fail to follow through on collaboration opportunities. To address these challenges, pharmacists can play a vital role in PCTs.

In addition to patient-centered care, pharmacists can directly impact quality measures used by CMS. For example, pharmacists’ roles are directly tied to certain medications, including statins for persons with diabetes. Additionally, pharmacists’ role in promoting value-based care services can influence many of the measures used by the Healthcare Effectiveness Data and Information Set, including actions related to hemoglobin A1c control and diabetes management.

Evidence of successful integration of pharmacists into Alternative Payment Models (APMs)

To better understand patient outcomes, a recent meta-analysis found that pharmacists were better able to manage patients’ complex medication regimens when working with other healthcare professionals. Furthermore, pharmacists’ role in interdisciplinary care management reduced health care costs and increased health outcomes. However, this type of work will only be successful if pharmacists are integrated into value-based care delivery. The next step is determining the best ways to incorporate pharmacists into integrated care programs.

One way to effectively integrate pharmacists into value-based care programs is to give them the support and opportunity to be recognized as key health care team members. For example, pharmacists can become PCT ambassadors by joining the Association of Family Health Teams Ontario (AFHTO) board of directors. Such participation improves pharmacists’ visibility and influence within the PCTs. Also, pharmacists can serve as patient advocates or on a PCT’s board.

Another effective way to involve pharmacists in value-based care initiatives is to reward them for improving patient outcomes. Currently, pharmacists are paid mainly on sales volume and are not incented to improve health outcomes for the population. Therefore, their interests are closely aligned with those of the pharmaceutical industry. But with partial outcome-based payment models, pharmacists can be rewarded for pharmaceutical care.

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