Optimizing the Medical Neighborhood
Whose responsibility is it when a patient is readmitted to the hospital after a cardiac event because they couldn’t get their blood pressure under control? Or when a patient taking hydrocodone and (unknown to the physician or pharmacist) is also taking cimetidine for heartburn, causing a fall? Whose responsibility is the full spectrum of patient care? More and more, the answer is everyone in the healthcare ecosystem—including pharmacists.
Laura Cranston, executive director of the Pharmacy Quality Alliance, has predicted that, over the next decade, pharmacy will be fully clinically integrated with the rest of the care team. In an interview with Drug Store News on the future of pharmacy, health economist Jane Sarasohn-Kahn agreed with Cranston’s assessment: “With the migration from volume-based payment to value, the healthcare provider . . . is taking on more risk in managing the outcome for their patients on an individual basis, or in terms of population health.” The pharmacy, she adds, “has a major opportunity to be the hub or platform in the health ecosystem.”
At the 2017 ThoughtSpot session “Optimizing the Medical Neighborhood,” Troy Trigstaad took a look at historical trends in the healthcare landscape: in the immediate post-war era, spending on care was episodic and providers stood in silos to handle acute situations as needed. In an episodic ecosystem, a primary care physician doesn’t have to pay too close attention to the fact that a patient ends up on the hospital several months after embarking on treatment. But today, he said, 86 percent of all prescriptions are filled by people with chronic conditions—and this older model doesn’t work.
The key takeaway is this: as we move toward a system that focuses on making people healthy, we need to continue to chip away at some of the barriers that have stood between members of the medical neighborhood, such as the wall of silence between physicians and pharmacists.
We’ve all seen the stats: a patient visits a primary care provider 3.5 times annually (for an average of 8 minutes of face time) but goes to the pharmacy 35 times annually. Still, there is a connection between the results for which both parties can be held accountable. That’s why measures like calculating 90-day hospital-readmission rates and Proportion of Days Covered have been developed. Trigstaad proposes this: physicians should contribute to the care provided by pharmacists—and he suggests they often are. “YOU JUST NEED TO ASK.” How do you get a physician to contribute?
- Position yourself and your pharmacists to talk to the rest of the healthcare system—we have a good story to tell.
- Ask for referrals—especially for complex patients. Collaboration is clearly the way that the care system is moving. According to Trigstaad, anyone with more than five or ten years left working as a pharmacist must be comfortable having these conversations with physicians.
- Consider alternatives. What would it take to get your delivery driver certified as a community health or home care worker?
- Measure your results. Granted, the pharmacist does not have access to measure all of the factors that impact hospitalization rates, but measure what you can.
As a matter of policy, the question of whether enhanced services—med sync, clinical check, immunizations, home visits, etc.—are pharmacy benefits or medical benefits still has to be answered. But there is no doubt that it is in the pharmacist’s long-term interest to begin framing his or her work as an investment in patient health and not a cost center.
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