The Pharmacist's Increasing Role in Moving Toward Greater Quality Care in a More Cost Effective Manner
OPINION -- One cannot help but read or hear about how the costs of drugs are going up and are becoming a greater percentage of the costs of treating patients. Many reasons are cited, including the greater costs of research and development for pharmaceutical companies, greater regulation, drug companies deciding to raise the prices of certain drugs because they believe they can do so, and direct to consumer (DTC) advertising making patients more aware of certain drugs that they might ask their clinicians to prescribe. In addition, pharmaceutical companies have been accused of paying other companies to keep their products from becoming generics or just paying them to delay introducing or marketing other drugs. Individuals seem to have more chronic diseases, more comorbidities and are taking a greater number of drugs. These more complicated patients seem to cost more to treat and often the costs and number of drugs are seen as a significant factor in the overall cost of healthcare.
The state of Vermont has responded by passing a law making drug makers justify their price increases. The Pharmaceutical Industry in Europe is considering pricing drugs to reward companies for the clinical benefit of the treatment. The Part D Medicare program is introducing an Enhanced Medication Therapy Management Program for 2017.
What does this mean to pharmacists and their profession? Pharmacists are going to need to take a greater role in assisting in the managing of patients' care and in ensuring that greater quality of care is provided in a more cost-effective manner. Medication Therapy Management (MTM) programs employ a group of services that pharmacists provide, including medication reconciliation, patient education, disease state management and medication safety surveillance. Pharmacists can manage a patient's individual therapies, comorbidities, and goals of therapy for optimization, in conjunction with a patient's care team.
If one were to take the costs of drugs as a constant, and this is not to say that one should, pharmacists can make a difference in the context of drug use management, where they develop and participate in drug use initiatives to support pharmacy goals and initiatives that promote quality, cost-effective drug therapy use. They can implement, track, evaluate and report utilization of targeted medications and individual doses and evaluate the impact of programs to insure safe and cost-effective prescribing. They can facilitate medication adherence which should increase health outcomes and the quality of life, decrease hospitalizations and readmissions, and prevent death.
Pharmacists can help manage the financial penalties under the new healthcare payment models where poor performance resulting from less than positive medication management might be experienced. They can develop and participate in patient medication adherence programs. They can assist in marketing programs to help both providers and patients utilize medications appropriately. They can help recognize socioeconomic factors through data review that might assist in patient care management. Such factors might include health risk factors, such as obesity and substance abuse, natural and built environmental factors, such as air and water quality and housing and neighborhood considerations. Other factors might include education, health literacy, and incomes. By recognizing the importance of these considerations, pharmacists may be able to better assist in managing a patient's care.
Pharmacists can use data analytics to identify and prioritize patients who might most benefit from certain interventions and the nature of those interventions. The may be able to identify patients who are not adhering to their drug regimens. They can engage in predictive modeling to identify which patients they might first focus on. Pharmacists might be able to identify misinformation in drug compendia. They also can use certain forms of health information technology in the context of medication safety, attempting to minimize the risk of medication errors and decrease errors in the process of dispensing a medication. Pharmacists can assist in tracking outcomes, whether they be process-related, harm-related, cost-related in nature, or otherwise.
The role of pharmacy professionals is expanding and their importance in the management of the health of patients, particularly in the evolving models where payment is made for quality and cost-effectiveness, will be a key driver in reducing the overall cost of drugs and health care. Finding appropriate mechanisms to compensate these professionals for their services will be important in facilitating their participation.
Paul R. DeMuro is an associate professor in the Department of Socio-behavioral and Administrative Pharmacy at the College of Pharmacy at Nova Southeastern University in Fort Lauderdale and Of counsel at Broad and Cassel. He can be reached at [email protected]