Pharmacists: The ‘Next Big Thing’ in Population Health Management

Partners For Kids (PFK), one of the country’s oldest and largest pediatric accountable care organizations, is a provider-based organization dedicated to population health management with three key aims: improved patient care experience, better population health and lower per capita health care costs. Because medications are a key factor in health care expenses, more than half of accountable care organizations use pharmacists to help achieve their three aims. PFK, however, has made pharmacists an increasingly integral part of their efforts to improve care quality, offer clinician training, improve patient satisfaction, reduce costs, and even boost patient adherence and high-risk behavior identification.

“The pharmacy role has evolved over time,” says Charitha Gowda, MD, MPH, MSCE, an associate medical director of PFK. “It went from predominantly being focused on pharmacy expenditures in the PFK population — such as finding ways to reduce costs by promoting generic prescribing over brand names — to more network- and practice-level interventions, working with quality improvement specialists on disease-specific management processes.”

Pharmacists now co-lead many of the organization’s quality improvement projects in asthma, reproductive health, ADHD, depression and other diseases that depend greatly on appropriate medication management. For example, the program’s pharmacists have used patient adherence to asthma medications (via data on prescription pick-up) as a marker of disease control. By bringing prescription-related data to the prescribers, patients with risk factors — such as filling too many rescue inhaler prescriptions — can get the extra attention they need before they end up with even bigger health problems.

“Pharmacists have extensive education and training in drug and disease nuances as well as patient-specific scenarios that impact the affordability and practical adherence issues for a medication,” says Brigid Groves, RPh, PharmD, MS, a clinical pharmacist at Nationwide Children’s Hospital and one of two PFK pharmacists. She co-authored an invited review paper about the involvement of pharmacists in PFK work, published in Children in July. “Pharmacists have the data and the background to really help physicians and other care providers — the diagnostic experts — by working with them to identify the most appropriate, efficacious, cost-beneficial and patient-friendly medications to use.”

Other PFK pharmacist-led endeavors include in-office chart review, prescription management education for participating providers, evaluation of provider-based prescribing habits, and prescription guideline development for common diseases. PFK pharmacists are now establishing partnerships with community pharmacists who can build long-term relationships with local providers to share data on their patients’ prescription behaviors, reinforce appropriate medication use and adherence when patients fill a prescription, and even relieve some physician burden by providing immunizations and other injection therapies.

“Our pharmacists have focused on and committed to developing evidence-based practice in pharmacy,” says Dr. Gowda, who is also an infectious diseases physician at Nationwide Children’s. “That has become the gold standard for how we manage patients clinically, and it’s the same rigor they’re trying to apply in pharmacy, using data to guide their actions and practices.”

This effort has brought pharmacists out of the historically transaction-related role to one deeply embedded in disease management and patient care. It is an endeavor that PFK leaders hope will result in demonstrable improvements in health outcomes, cost and quality in numerous disease categories.

“Pharmacists have that unique ability to see specific medication-related problems that might arise and to develop and implement solutions for both individual patients and their patient population as a whole,” says Dr. Groves, who is also president of the Ohio Pharmacists Association.

PFK aims to set the tone for other accountable care organizations by publishing current and future data on health outcomes. They also hope to grow the network of pharmacists involved in patient care in Ohio and beyond.

“Through the work I’ve been able to do with our pharmacists, I’ve come to have a greater appreciation for how they can really come alongside the clinician to optimize care for patients,” says Dr. Gowda. “They are often an underrecognized or underutilized resource. To the extent clinicians and others can partner with the pharmacists, they may identify innovative ways to improve patient health.”

Drs. Gowda and Groves and their PFK colleagues also hope to delineate ways in which pharmacists can account for their time educating and administering medications to patients in the wake of 2018 Ohio legislation acknowledging pharmacists as health care providers.

“If PFK is a catalyst across the state or even the nation to showcase the positive impact a pharmacist can have on patient care through education and information,” says Dr. Groves, “I think we can take things to the next level of providing great care in partnership with physicians, and maximize our impact on kids.”

Reference:

Kuhn C, Groves BK, Kaczor C, Sebastian S, Ramtekkar U, Nowack J, Toth C, Valenti O, Gowda C. Pharmacist involvement in population health management for a pediatric managed Medicaid accountable care organization. Children. 2019 Jul;6(7):82.

Image credit: Nationwide Children’s Hospital