Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
UPMC Center for High-Value Health Care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Manag Care Spec Pharm. 2019 Sep;25(9):995-1000. doi: 10.18553/jmcp.2019.25.9.995.
The shift to a value-based health care system has incentivized providers to implement strategies that improve population health outcomes while minimizing downstream costs. Given their accessibility and expanded clinical care models, community pharmacists are well positioned to join interdisciplinary care teams to advance efforts in effectively managing the health of populations. In this Viewpoints article, we discuss the expanded role of community pharmacists and potential barriers limiting the uptake of these services. We then explore strategies to integrate, leverage, and sustain these services in a value-based economy. Although community pharmacists have great potential to improve population health outcomes because of their accessibility and clinical interventions that have demonstrated improved outcomes, pharmacists are not recognized as merit-based incentive eligible providers and, as a result, may be underutilized in this role. Additional barriers include lack of formal billing codes, which limits patient access to services such as hormonal contraception; fragmentation of Medicare, which prevents alignment of medical and pharmaceutical costs; and continued fee-for-service payment models, which do not incentivize quality. Despite these barriers, there are several opportunities for continued pharmacist involvement in new care models such as patient-centered medical homes (PCMH), accountable care organizations, and other value-based payment models. Community pharmacists integrated within PCMHs have demonstrated improved hemoglobin A1c, blood pressure control, and immunization rates. Likewise, other integrated, value-based models that used community pharmacists to provide medication therapy management services have reported a positive return on investment in overall health care costs. To uphold these efforts and effectively leverage community pharmacist services, we recommend the following: (a) recognition of pharmacists as providers to facilitate full participation in performance-based models, (b) increased integration of pharmacists in emerging delivery and payment models with rapid cycle testing to further clarify the role and value of pharmacists, and (c) enhanced collaborative relationships between pharmacists and other providers to improve interdisciplinary care. DISCLOSURES: This article was funded by the National Association of Chain Drug Stores. The authors have no potential conflicts of interest to report.
向以价值为基础的医疗保健系统的转变激励提供者实施能够改善人群健康结果同时尽量减少下游成本的策略。鉴于其可及性和扩展的临床护理模式，社区药剂师非常适合加入跨学科护理团队，以推进有效管理人群健康的工作。在这篇观点文章中，我们讨论了社区药剂师的扩展角色以及限制这些服务采用的潜在障碍。然后，我们探讨了在以价值为基础的经济中整合、利用和维持这些服务的策略。尽管社区药剂师具有通过其可及性和已证明可改善结果的临床干预措施来改善人群健康结果的巨大潜力，但药剂师未被视为基于绩效的有资格获得奖励的提供者，因此在这种角色中可能未得到充分利用。其他障碍包括缺乏正式的计费代码，这限制了患者获得诸如激素避孕等服务的机会；医疗保险的碎片化，阻止了医疗和药品成本的对齐；以及持续的按服务收费的支付模式，这不利于质量的提高。尽管存在这些障碍，但社区药剂师仍有机会继续参与新的护理模式，如以患者为中心的医疗之家（PCMH）、问责制医疗组织和其他以价值为基础的支付模式。在 PCMH 中整合的社区药剂师已证明可以改善糖化血红蛋白、血压控制和免疫接种率。同样，其他整合的、基于价值的模式，利用社区药剂师提供药物治疗管理服务，也报告了在总体医疗保健成本方面的投资回报为正。为了维护这些努力并有效地利用社区药剂师服务，我们建议：（a）承认药剂师是提供者，以促进他们全面参与基于绩效的模式；（b）增加药剂师在新兴交付和支付模式中的整合，并进行快速循环测试，以进一步明确药剂师的角色和价值；（c）加强药剂师与其他提供者之间的合作关系，以改善跨学科护理。披露：本文由全国连锁药店协会资助。作者没有潜在的利益冲突需要报告。
