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May 1, 2009
Pharmacist Coaches Help Chronic Disease Patients
By Les Masterson, for HealthLeaders Media
As the rate of chronic disease skyrockets, health costs balloon, and physicians struggle with demands on their time, health officials have increasingly turned to pharmacists as a possible solution.
Pharmacists have taken on a greater presence on the healthcare team in programs like the Asheville Project and Medicare Part D's Medication Therapy Management, which have featured pharmacist coaches helping chronic disease patients manage their ailments.
The latest example is the Diabetes Ten City Challenge, which the American Pharmacists Association (APhA) Foundation created to test whether the pharmacist coach model works in diverse geographies and various employer types.
The final economic and clinical results for the DTCC found that combining pharmacist coaches with value-based insurance design helped diabetic patients manage their chronic disease.
According to the study that was published in the May/June issue of the Journal of the American Pharmacists Association, average healthcare costs for those involved in the project were reduced by $1,079 per patient annually and the participants saved an average of $593 per year on their diabetes medications and supplies because DTCC employers waived copays.
The program also improved patients' key clinical measures, including lowering A1C and cholesterol levels to achieve American Diabetes Association and National Cholesterol Education Program goals; and lowering diastolic/systolic blood pressure levels to below the 130/80 goal. The project also fostered improvements in preventive care measures, including flu vaccinations, current foot exams, and current eye exams.
William M. Ellis, CEO of the American Pharmacists Association (APhA) Foundation in Washington, DC, and co-author of the study, says the results show that pharmacist coaches could impact chronic disease, reduce adverse drug events, and improve medication compliance.
Pharmacist coaches can meet with patients longer than doctors, who are stretched for time, and they can help fill a gap left by physician shortages.
"Physicians today are asked to do so much in an office visit in a really short amount of time," says Ellis. "The things they have to cover with a patient are really more than I think can be done in a lot of office visits. To have the extra support of a pharmacist to reinforce those things is valuable."
According to the study, the APhA Foundation found successful pharmacist coaching programs feature the following:
- An employer that invests in incentives for patients and providers to improve health and lower costs
- Employers who are involved in program implementation and have an open culture with their employees
- Receptiveness of healthcare providers who support community-based collaborative care
- A local network of pharmacists with the motivation, training, and time to help patients manage their care
- Health plans willing to provide claims data for analysis
"This whole area, I think, is emerging from pharmacy networks that are based on drug distribution to the emergence of pharmacy networks that will be based on patient care," says Ellis.
The employers that took part in DTCC were self-insured so they were at risk for both medical and prescription costs for their employees and beneficiaries. The employers/health plans created incentives for patients and pharmacists, including waived copays for medications and certain supplies, and pharmacists were paid for their coaching services.
During regularly scheduled appointments, pharmacists "applied aprescribed process of care that focuses on clinical assessments and progress toward clinical goals and work with each patient to establish self-management goals. In addition, they worked with other healthcare providers and could recommend adjustments in the patients' treatment plans when appropriate," according to the study.
These private visits allowed patients to ask questions, and the pharmacists were able to identify problems and teach self-management skills.
One of the 10 DTCC sites was led by the Northwest Georgia Healthcare Partnership (NGHP), based in Dalton, GA. The nonprofit includes healthcare providers, businesses, payers, government, and educators, who look to improve the health of residents in Whitfield and Murray counties.
Nancy Kennedy, executive director of NGHP, says an important part of the DTCC is that pharmacists are not replacing doctors or diabetes educators. Instead, they are there to help patients between doctors' appointments and update the physicians about their patients' health.
Similar to many parts of the nation, Northwest Georgia is facing a primary care physician shortage. Through visits with patients, the pharmacists are able to provide face-to-face case management.
She says patients feel a close bond with pharmacists and aren't afraid to ask them medical questions. Having that friendly relationship also allows for more honest communication.
"That accountability, face-to-face accountability, with someone in your community that you know, that you see on a regular basis to me is what makes this program so phenomenal and strong," says Kennedy.
One of the businesses that participated in Northwest Georgia, Hamilton Health Care System, made sure the project was not just a freebie for diabetics. The patients had to follow their prescription regimen, exercise regularly, and maintain a proper diet to remain in the program.
"We both have skin in the game so to speak," says Jason Hopkins, director of human resources at Hamilton Health Care System, about the employer and employee. "That helps both the investment we put forth to these individuals, but also in theory motivates them to comply."
Hopkins says Hamilton did not achieve great financial savings and probably broke even in the DTCC, but added that the health system should realize preventive savings through diabetics taking better care of themselves.
Hopkins says many businesses are reactive when it comes to tackling rising health costs. They pass costs onto employees by increasing copays and deductibles. That works to a certain extent, but employers must draw the line eventually, he says.
"I think what this tells the healthcare community is that one, you can incentivize your associates to take better care of themselves, that's what the healthcare providers want to see, but from the industry standpoint I think this proves to them that they don't have to push off more cost onto their employees. They can actually pay more, but ultimately in the long run see better financial outcomes because [employees] are taking better care of themselves," says Hopkins.
Though DTCC showed positive results, many pharmacies could not offer the same level of coaching services at this point. In order to have more pharmacist coaches, Ellis says the following should happen:
- Pharmacies will need to redesign their areas to create private consultation rooms
- Healthcare will need to improve health information systems, such as electronic health records, which could lead to better data exchange
- Employers will need to understand pharmacy coaching programs bring long-term savings and not view them solely as an expense
- Payers will have to change the way they reimburse pharmacists to include payment for providing coaching services
Ellis says pharmacists add value to the healthcare system by providing evidence-based treatments that can improve patients' health. Better health means lower employer costs and increased productivity.
"We're at a point now in healthcare that a lot of people are looking at the healthcare system in total and looking at how can we revitalize it, how can we change it, how can we improve it? This is an example of the promising practices that could lead to a reformed healthcare system in this country," says Ellis.
The APhA Foundation is now looking to expand the tenets of the DTCC to other disease states, including hypertension, low back pain, asthma, and chronic obstructive pulmonary disorder.