Henry Ford once said, “Coming together is a beginning. Keeping together is progress. Working together is success.”
Fast forward to today and Ford’s observation is applicable to health care. Studies estimate that as much as one-third of the approximately $2.8 trillion in annual U.S. health care expenditures is wasteful. A recent Medicare innovation grant embodies how community pharmacists are working to reduce waste and deliver better care.
The Centers for Medicare and Medicaid Services (CMS) has a directive to help rein in the cost of the federal programs they oversee. As part of the Affordable Care Act the Center for Medicare & Medicaid Innovation Center (CMMI) was established in CMS to find “innovative payment and service delivery models to reduce program expenditures …while preserving or enhancing the quality of care”. CMMI’s experimental pilot programs bring stakeholders together to develop creative approaches and gauge their feasibility for adoption throughout the country.
In October the Community Care Network of North Carolina, Inc. (CCNC), the UNC Eshelman School of Pharmacy and GlaxoSmithKline (GSK) were awarded a more than $15 million grant “to develop, implement and test new approaches to care delivery with goal of helping lowering health care cost through the better use of medicines.” When you consider that according to the Network for Excellence in Health Innovation (NEHI), up to $290 billion is wasted annually on the improper use of medication, any coordinated program that aggressively drives medication adherence and incorporates pharmacies into a “patient-centered medical home” has potential for better outcomes and considerable savings.
What makes the effort in North Carolina unique is not only the focus of developing a single point-of-contact to help coordinate care, arrange assistance from other caregivers when necessary, and house electronic health records, but also the use of analytically driven research to guide how patients benefit.
The UNC Eshelman School of Pharmacy will identify and create an intervention plan for high-risk patients before the onset of potential health complications. For example, seniors who take 10 or more prescription drugs and are discharged from the hospital after an extended stay are natural targets. Whether it is the doctors treating the patient or the insurance plan facilitating the coverage, all have a vested interest in preventing a readmission.
Joe Moose, PharmD, is the Lead Community Pharmacy Coordinator for CCNC. Moose develops the services participating community pharmacies will deliver at the point of care, manages their work flow, and recruits other leading pharmacies to the Community Pharmacy Enhanced Service Network (CPESN).
Moose and CCNC have long embraced the goal of helping patients maximize their drug regimens, which can reduce the likelihood of costly emergency room visits and hospitalizations. They believe that while a proactive and preventative approach to a patient’s health might entail some additional upfront spending, the long-term benefits of overcoming those challenges will lessen the massive outlays that can occur later. CCNC, which was founded in 1998, has already saved billions in costs through its approach to patient care.
Moose is a fourth-generation pharmacist, who works with his brother Whit Jr. to oversee the operations for Moose Pharmacy’s five locations that are on the cutting edge of health care delivery in the greater Charlotte, N.C. area. In addition to his role with CCNC, Moose is co-chair of the NC Medicaid Drug Regimen Review Board, a member of the Pharmacy and Therapeutics committee for NC Medicaid, and an adjunct assistant professor at UNC Eshelman School of Pharmacy.
The CMMI grant allows medication experts like Moose to prove the merits of expanding their role and level of compensation in healthcare. For too long pharmacists efforts in this regard have been hindered since they aren’t officially recognized in federal statute as health care providers – although legislation has been introduced that would recognize pharmacists as providers. The CMMI grant knocks down those barriers, and will hopefully identify and spread ground-breaking efforts to reinvent health care deliver with the aid of pharmacists.
B. Douglas Hoey is a pharmacist and CEO of the National Community Pharmacists Association