Community pharmacist and family medicine clinic provision of chronic care management services for Medicare beneficiaries with uncontrolled hypertension

Community Pharmacist and Family Medicine Collaboration for Pre-Visit Planning for Shared Patients Receiving Chronic Care Management Services

Background: Pre-visit planning entails completing necessary tasks prior to clinic appointments. Community pharmacists (CPs) have unique knowledge about patients' medication use but do not routinely provide drug therapy reviews before clinic visits. Objectives: (1) Create and implement a business partnership between a CP and family medicine clinic (FMC) for CP provision of pre-visit medication reviews, and (2) describe the billing experience for shared patients in the FMC chronic care management (CCM) program. Methods: A prospective 8-month study in one community pharmacy and FMC in Iowa. Eligible patients were enrolled in the clinic CCM program and received their prescriptions at the CP. CPs were granted access to the clinic electronic health record (EHR), performed medication reviews, and recorded drug therapy recommendations (DTRs) in the clinic EHR. FMC physicians reviewed CP DTRs before the patient encounter. Time tracking software in the EHR recorded CP and FMC time performing CCM services. CCM revenue was prorated between parties. FMC physicians completed a survey about their experience. Results: Overall, there were 129 CP reviews performed for 95 patients. These reviews resulted in 169 DTRs and 76% were accepted by the physician. There were 71 CCM claims billed and CCM revenue was $3596 ($1796 FMC, $1800 CP). More than 90% of physicians (N = 11) indicated they reviewed CP DTRs before the patient encounter and agreed they were helpful to their practice. Conclusion: CPs completed pre-visit medication reviews and made accepted medication therapy recommendations. CCM billing provided a mechanism for CPs to receive revenue for their services.

Improvement in Clinical Outcomes and Access to Care With Pharmacist-Led Chronic Care Management Services at a Rural Family Medicine Clinic

Background: Chronic care management (CCM) can significantly impact the management of chronic diseases in rural patient populations. To date, few practice models have addressed its impact on clinical outcomes and access to care in rural practice settings. Objective: Implement a sustainable pharmacist-led CCM practice model while tracking clinical outcomes and healthcare access at a rural, medically underserved family medicine clinic. Methods: This study retrospectively examined data from the clinic's CCM program from October 2020 through May 2021 and included total clinical encounters at three- and 6-months intervals, as well as changes in clinical outcomes like A1c and systolic blood pressure (SBP) at three- and 6-months intervals. Results: Over an 8-month period, 46 patients were enrolled in pharmacist-led CCM services. Those with a CCM encounter or office visit within 3 months of enrollment showed a mean A1c reduction of 1.07% after 3 months (95% CI -1.70 to -.44, P = .0016), while those with an encounter or office visit within 6 months of enrollment displayed a mean A1c reduction of 1.64% after 6 months (95% CI -2.35 to -.92, P < .001). There was a 73.8% increase in total clinical encounters in the 6 months after CCM enrollment compared to the 6 months preceding it, signifying increased access to care. Conclusion: Patients with CCM encounters or office visits within the first 3-6 months experienced statistically significant reductions in A1c. Moreover, total clinical encounters markedly increased in the 6 months after enrollment, allowing for more frequent engagement between ambulatory pharmacists and traditionally challenging rural patients.

Patient satisfaction with pharmacist-led chronic care management services combined with medication synchronization

PURPOSE

Chronic care management (CCM) improves clinical outcomes, enhances patients' adherence with medical treatments, reduces overall cost, and increases patient satisfaction. However, multiple reports have indicated the underutilization of CCM. Implementation literature has emphasized feasibility and different approaches to providing pharmacist-led CCM. This article examines patient acceptability and provides an innovative implementation approach combining both CCM and medication synchronization (MedSync) services.

SUMMARY

To introduce CCM services to underserved Medicare beneficiaries at a federally qualified health center, the pharmacy department of a federally qualified health center (FQHC) pilot tested a program whereby pharmacists provided CCM to Medicare beneficiaries enrolled in the MedSync service offered by the FQHC's in-house pharmacies. Both services were provided during the same phone call by the pharmacist. After successful completion of the pilot program, a retrospective chart review and patient satisfaction survey were conducted to enhance the quality of the service. A total of 49 patients were enrolled in the CCM program at the time of data collection. Overall, participants were satisfied with the service. The average number of medications per patient was 13.7. Pharmacists were able to identify an average of 4.8 medication-related problems (MRPs) per patient. Most of the MRPs (62%) were resolved directly by the pharmacists via education, over-the-counter medication adjustments, or interventions under consult agreements.

CONCLUSION

In addition to positive patient satisfaction, pharmacists were able to identify and address a significant number of MRPs when providing CCM.

Analysis of provider-generated revenue and impact on medication reconciliation from a pharmacist-led chronic care management service

BACKGROUND

Published data on pharmacist-provided chronic care management (CCM) services is limited, particularly for programs led by community-based pharmacists.

OBJECTIVE

The objective was to quantify the total revenue generated from a community pharmacist-led CCM service, including CCM billing and appointment referrals. A second objective was to identify the types and frequencies of medication discrepancies identified during medication reconciliation.

PRACTICE DESCRIPTION

Realo Drugs is a group of 18 independent community pharmacies serving eastern North Carolina.

PRACTICE INNOVATION

Exploration of revenue generated from a community pharmacist-led CCM service.

EVALUATION METHODS

This retrospective analysis assessed interventions completed by pharmacists between April 1, 2018 through June 30, 2019. Data was extracted from the electronic health record (EHR), including revenue generated from CCM billing codes, appointment referrals made by the pharmacist resulting in a completed in-office appointment, and which patients received medication reconciliation. The types and frequencies of medication discrepancies were documented, including medication no longer being used by the patient, medication omission, and strength or dose mismatch. Descriptive statistics were used to analyze data.

RESULTS

Over 15 months with a total of 112 patients, a total of $26,148 was generated from CCM services, representing an average of $15.56 per patient per month. The majority (approximately 80%) of the revenue was generated from noncomplex patient encounters. Of the 239 medication reconciliations completed, 609 medication discrepancies were identified. The majority of medication discrepancies (67%) were categorized as "patient no longer takes medication listed on EHR medication list." The second most common discrepancy was "patient takes medication not listed on the EHR medication list" (22%), followed by "strength/dose mismatch" (10%).

CONCLUSION

These data can demonstrate to provider partners the sources of revenue that can be provided through CCM services. In addition to revenue, pharmacists can positively impact patient care through identification of medication discrepancies through medication reconciliation.