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ACO’s Emerging Potential: Pharmacists on the Care Team

BY SALINA WONG, PHARMD – Blue Shield of California is strengthening the integrated care teams within its Accountable Care Organizations (ACOs) by helping provider partners add pharmacists to their health care teams, and making available a network of advanced practice pharmacists who can provide services on referral.

The United States National Library of Medicine-National Institutes of Health reports that America’s healthcare system spends an estimated $290 billion each year on unnecessary medical services due to the misuse of medications and more than $177 billion annually on treating adverse drug reactions, many of which could be prevented with effective medication management.  The rising cost of prescription medications due to these factors and its impact on overall healthcare costs makes it an important area for Blue Shield and its ACOs to focus, leveraging the expertise of pharmacists in all care settings.

While pharmacists have always been involved in the healthcare delivery system, the ability of pharmacists to provide patient care with other members of the healthcare team has been expanded significantly with bipartisan support and passage of California’s pharmacist provider status legislation (SB 493, Hernandez. Pharmacy Practice) in 2013.  This will result in greater access to care plus improvements in quality, patient outcomes, and efficiency in the healthcare delivery system.

“As the drug expert, pharmacists have unique clinical skills that allow them to build trusting relationships with patients and collaborative partnerships with providers. These relationships directly translate into high patient engagement rates and significant shifts toward judicious prescribing,” says Khanh Nguyen, PharmD, Director of Clinical Support at Hill Physicians, a Blue Shield ACO partner.

Integration of pharmacists into care teams within our ACO network has escalated quickly over the past five years as our Blue Shield ACO team drove initiatives to help provider partners understand the value that pharmacists practicing at the top of their license can bring.  Their participation on a team to help manage chronic conditions such as diabetes, heart problems, asthma, stroke and high blood pressure can reduce or prevent hospital readmissions and emergency room visits, an important step in improving patient outcomes and lowering healthcare costs.  In addition to defining value, Blue Shield ACO pharmacist program managers have created a path and plan for ACO partners to use pharmacists in their practices, including contracting an advanced practice pharmacist network, to realize that value.

While still in progress of gathering and analyzing metrics around the impact of pharmacists in ACOs, the initial results are good.  Studies to date show that when pharmacists are part of the integrated team of care providers, prescribing habits among physicians improves, as does patients’ medication adherence, and patients achieve better health outcomes and lower healthcare costs.

”Our pharmacists have developed a relationship with the patients they touch, which makes motivational interviewing more effective,” notes Dr. Nguyen.  “We have observed a consistent improvement in medication adherence.  Our physicians receive positive feedback from patients, and requests for a pharmacist to contact the patients continues to increase.”

Innovation has been at the heart of Blue Shield’s ACO network since it was established in 2010 and that continues today.  More pharmacists are joining integrated healthcare teams in our ACOs and advanced practice pharmacists will be available in Blue Shield’s provider network for ACO providers to leverage for patient care. All of this is to bring more value to our members and help to support our mission to provide all Californians access to quality health care at an affordable price.

Salina Wong, PharmD, is director of clinical pharmacy programs at Blue Shield of California