Primary Care
Pharmacists are widely recognized as medication therapy experts. As a result, pharmacists help patients make the best use of their medications! Since safe and effective medication management plays a key role in not only keeping people healthy but also in managing chronic conditions in the primary care setting, pharmacists are uniquely positioned to help address the primary care shortage while decreasing cost and improving outcomes.
Background
Currently, physicians, nurse practitioners, physician assistants and increasingly, pharmacists provide primary care services including engaging in public health and driving population health in the primary care practice.
CMS defines the following three components of Primary Care: primary care, preventive care, or care coordination. Addressing the social determinants of health and engaging in population health are also key components.
Pharmacists are already playing a unique role as the medication therapy expert in a variety of primary care settings providing a wide variety of primary care services including wellness and prevention, acute and chronic care management, medication optimization, population health, and public health as well as addressing social determinants of health. However, pharmacists are not currently officially recognized as part of the primary care workforce.
Conclusion: The role of the pharmacist needs to be more universally accepted, regularly integrated, and pharmacists need to be formally recognized for the value their expertise and care add to the team.
A shortage of current and future primary care providers has been consistently predicted and unfolding over the last decade reflecting a general need for all primary care services. The number of pharmacy and medical deserts are expanding, especially in rural and underserved areas. The following primary care area shortages have been specifically identified: chronic care management, preventive services, behavioral health, geriatric care, women’s health, and oral health.
Pharmacists have been shown to increase access to primary care services, decrease the total cost of care, improve outcomes and avoid medication misadventures by optimizing the use medications.
Conclusion: An urgency exists to maintain access to pharmacies as well as to expand coverage of and to scale pharmacist provided primary care services to care for patients who are in ever growing pharmacy and medical deserts.
Opportunity
The role of the pharmacist as the medication therapy expert in primary care needs to be formally recognized, scaled, and appropriately compensated to address the unmet needs of communities, especially for the medically underserved and those living in rural areas.
Aspirational Goal: Every patient will have a pharmacist who is responsible for maintaining a current, active medication list in the interoperable health record; optimizing the patient’s medications; and avoiding medication misadventures.
Gap Analysis
To move forward, a gap analysis and assessment were completed to drive a current action plan. A review was conducted across multiple reported delivery models and deliberations to identify common elements required to advance the role of the pharmacist in primary care. Resources were included from multiple organizations, collaboratives, and journals.
Using inductive coding, six central themes were identified as essential elements for the role of the pharmacist in providing primary care:
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Workforce (includes the themes: training and wellbeing)
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Scalable patient care services (includes the themes: practice model, consistency, credibility, and marketing)
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Payment
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Legal, regulatory, and advocacy
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Health information access and exchange and technology
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Outcome data analysis (includes the theme: research)
Each identified element was then assessed for status in the current healthcare environment to assist in the development of guiding principles and strategic aims to advance the role of the pharmacist in the evolving environment.
Action Plan
Based on the previously described environmental scan and gap analysis indicating an urgent increased need for primary care services especially in underserved areas, a fluid action plan was designed. The action plan is built on the foundation of the pharmacist is the medication therapy expert, pharmacists provide value-added services to the primary healthcare team, and pharmacists can provide primary care services in a variety of practice settings.
The progression of the steps and guiding principles were developed from the central themes identified through inductive coding as essential elements for the role of the pharmacist in providing primary care. The initial strategic aims are drawn from recommendations collected from the documents and resources assessed during the inductive coding process and gap analysis.
Framework for Scaling the Role of the Pharmacist in Primary Care
Overarching Goals:
The role of the pharmacist as the medication therapy expert in primary care is formally recognized, scaled, and appropriately compensated to address the unmet needs of communities, especially for the medically underserved and those living in rural areas.
Scalable, consistent, and predictable primary care services impacting patient access, outcomes, and cost that align incentives are established to support fair payment across teams of providers that include pharmacists as essential members of the primary care team.
Aspirational Goal:
Every patient will have a pharmacist who is responsible for maintaining a current, accurate medication list in the integrated health record, optimizing the patient’s medications, and avoiding medication misadventures.
Step Action Guiding Principles
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Drive scalable pharmacist provided primary care services
Credible primary care services provided by the pharmacy workforce will be consistently and predictably delivered and sufficiently scaled to justify coverage and sustainable payment.
2
Inspire pharmacists and support staff to provide primary care services
1) Schools/Colleges educate all student pharmacists as medication therapy experts capable of providing primary care.
2) A sufficient number of pharmacists and pharmacy technicians willing and able to provide sustainable primary care services will be accessible in communities with high demand for primary care services.
3
Advance services with needed technology
1) All providers on the team, including pharmacists, have access to technology needed to deliver and communicate patient care services including “read and write” access to integrated health records.
2) Pharmacists can utilize data from integrated health records to implement quality improvement initiatives and population health services.
3) Pharmacists are experts in utilizing patient care technology used to monitor medication therapy.
4) Pharmacists have the needed interoperable technology to provide, bill for, and track pharmacist provided primary care services.
4
Measure the value of pharmacists providing primary care
Pharmacist contributions are accurately and consistently measured to reflect the value of the pharmacist in providing high quality primary care services and incorporated into the organizational resource allocation decision-making process.
5
Support and promote pharmacists providing primary care services
1) All members of the healthcare team, including pharmacists, are paid fairly for their services.
2) Pharmacy workforce is empowered to practice under a standard of care model that allows full practice authority.
3) Advocacy agenda of partners supporting pharmacists providing primary care aligns with the framework guiding principles.
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Obtain payment for pharmacist provided primary care
1) Pharmacists are included as essential members of the healthcare team.
2) Incentives are aligned with patients, payers, and providers for pharmacist to be paid fairly for pharmacist-provided primary care services.
Using the concepts from Good to Great (Jim Collins), a flywheel was created establishing causality between the components.
Although the overarching goals, steps, guiding principles, and strategic aims will remain consistent across practice settings, objectives and tactics may vary based on the unique opportunities and challenges experienced in each practice setting. The application of the same guiding principles and strategic aims across practice sites will guide the implementation to be consistent and scalable in the marketplace. Permitting flexibility in objectives and tactics will allow strategies to emerge to address unique needs in different practice settings.
The Action Plan is intended to be used across all practice settings. The mission of the plan is twofold. An individual practice or organization can use the framework to advance the role of the pharmacist in primary care at the practice or organization level. At the same time, regional and national stakeholders can use the framework to collaborate, reduce duplications of effort, and advocate with one voice for the role of the pharmacist in primary care.
Download the Complete Action Plan with detailed background and gap analysis
Primary Care Business Plan Appendices
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