Medication adherence & pharmacists: A $200 billion opportunity
Chronic diseases are a formidable public health challenge for the U.S. with more than 50 percent of Americans living daily with one or more chronic health conditions. The impact of these illnesses can be debilitating for individuals, families and local communities. Approximately 75 cents of every dollar spent on health care in 2009 was related to chronic illnesses which totaled $1.7 trillion.
The main weapon available to treat chronic diseases, such as diabetes or high blood pressure, is medications. The average number of medications prescribed per capita increased from 10.1 in 1999 to 12.7 in 2014. In fact, one of the most effective means to improve health outcomes is to ensure medications are taken appropriately.
As health reform evolves, millions of Americans are joining the ranks of the insured. And as our society continues to age, the opportunities to achieve better quality, improved outcomes and more affordable care are even greater. Medication adherence is an important yet often overlooked dimension. A report by the IMS Institute for Healthcare Informatics summarizes the avoidable costs in U.S. healthcare and emphasizes that the responsible use of medicines is a $200 billion opportunity for improved care. Annually, there are more than 1.5 million preventable medication-related adverse events in the United States and poor adherence alone results in $100 billion in excessive hospitalizations. More is needed to ensure medications are optimally managed to deliver their maximal effectiveness.
Pharmacists are a solution to this public health challenge. Services provided by pharmacists have grown beyond the process of dispensing medication. This statement may surprise many, as most people may still associate pharmacy with a product and not realize the dimension of services they can deliver. This may, in part, be attributed to the slow and sporadic implementation of some pharmacist-provided services across the country. In a report to the U.S. Surgeon General, pharmacists were identified as an underutilized opportunity to improve healthcare for a transformed healthcare system in need of primary care services. Extensive literature has documented the positive return on investment when pharmacists are strategically deployed to assist the healthcare team with coordination of medications during transitions from hospitals to home care, medication management, disease education, prevention and wellness services, and patient education. Pharmacists are increasingly working with physicians to initiate and modify medications, guided by collaborative agreements, which increases valuable time for primary care physicians to schedule more patient visits.
The profession of pharmacy quietly transformed itself over the last two decades. One important element of this transformation was the national conversion to an entry-level Doctor of Pharmacy (Pharm.D.) degree and the emergence of post-graduate pharmacy residency education as an important aspect to delivering direct patient care. Today, approximately 50 percent of the pharmacy workforce has been educated within this new curricular model. The Interprofessional Education Collaborative (IPEC) was also formed nationally to further define interprofessional education (IPE) and the competency domains important to advancing education in ways to create the next generation of “team-ready” health professionals. These and other initiatives have prepared pharmacists and influenced the health care ecosystem toward a more integrated, collaborative model of delivering patient-centered and population-based care. Despite these advancements, pharmacist-provided services are only minimally incorporated into emerging models such as accountable care organizations, transitions of care, employee health benefit strategies, and patient-centered medical homes. It is imperative for the United States to create a pool of healthcare professionals across all health disciplines, prepared and capable to function within innovative, team-oriented models, while simultaneously modifying healthcare policy to catalyze these opportunities.
There are important health policy issues that pose challenges for the widespread utilization of pharmacists to the fullest capacity. First, pharmacists are not currently designated as providers under the Social Security Act. As such, pharmacists cannot submit claims to medical insurers; therefore, there is no record of their participation in the care of patients or their contribution to meeting quality outcomes. Recognition as providers would help to overcome some of the barriers to incorporation of pharmacists into team-based models of care. In fact, it would be ideal to have a national network of pharmacists providing these advanced pharmacist services and leveraged in conjunction with local health-systems, health plans and corporations to deploy services most effectively.
In addition to provider status, it is imperative that pharmacists have access to important health information regarding patients or populations being served by their services. It is very challenging today to interface easily in health information exchange and in many cases pharmacists are not included in the conversation. More is needed to link patient information into a shared repository that aligns electronic medical records, prescription claims data, and outcomes related to services provided by a pharmacist. For example, a patient’s list of medications is not conveniently and accurately communicated between pharmacy and other health providers involved in the care of the patient, and it is common for a person to receive an immunization within a community pharmacy, but more often than not it doesn’t get communicated conveniently back to the primary care physician as part of medical record.
Finally, pharmacist-provided services should be more extensively incorporated into federally-funded research initiatives to further study the value these services bring to all stakeholders. Implementation science initiatives would greatly benefit the widespread incorporation of best-practices across the U.S. related to utilizing pharmacists strategically. This could accelerate the utilization of valuable services and provide additional evidence to advocate for policy changes. Our goal should be to ensure that any person who would benefit from a pharmacist-related service has access to it.
While chronic illnesses are not curable, they can be managed in ways to improve the quality of life for our society. It is time to shine a bright light on the potential that pharmacists can bring to the healthcare challenge. It is a $200 billion issue that America can’t ignore.
Charles Taylor, Pharm.D., is dean of the College of Pharmacy and vice president of academic affairs at Northeast Ohio Medical University.