By Matt Phillion
Every year in the U.S., inaccurate prescribing, medication errors, adverse drug reactions, skipped doses, or treatment failures lead to 275,000 deaths and $528 billion wasted. With the aging population where almost nine out of 10 seniors are on at least one medication and most of those patients prescribed more than one med, these issues are primed to grow more challenging.
What can the industry do to address this? Experts point to a holistic approach integrating pharmacists into primary care teams and comprehensive medication management (CMM) that assesses each patient’s medications for appropriateness, effectiveness, safety, and adherence. This whole person model leads not only to patient safety improvement and better outcomes, but improved ROI as well.
“Patient safety first and foremost, but this is a bit of a different spin, taking pharmacists and using them how we’re trained,” says Kerri Musselman, VP of Pharmacy Care Solutions with Emcara Health. “The dispensing side has always been the bread and butter of where the pharmacy is traditionally seen, but there’s so much more to offer in how we care for the patient.”
Pharmacists are uniquely skilled in explaining how medications work, where they intersect, and how they treat different disease states, Musselman says.
“That goes back to our training: we spend four years just focused on medications and how they impact the body. We have the critical thinking space, the analytic space, and understand the pain points for medication management and how this all wraps around the primary care team and specialty space,” says Musselman. “This is an excellent opportunity and a pivotal point in space with burnout, staffing shortages, increased requests for immunizations and testing.”
There’s a lot of talk about a pharmacist shortage, but Musselman notes it’s not a lack of skilled, trained personnel.
“We don’t have a shortage of pharmacists. They want to work in a different space, want to be able to help the patient, be more engaged, provide the CMM, give medication reviews, help with chronic disease management,” she says.
“I defer on the diagnostic side, that’s not my area of expertise, but if you tell me what you’re treating, I can give you the best option and meet the patient where they are, looking at comorbidities with over-the-counter medications, and offering a comprehensive review,” says Musselman.
The industry is overlooking the opportunity to put that expertise to work for better and more comprehensive patient care, she notes.
“During the pandemic, you saw a lot of pharmacies offering COVID vaccinations, and there’s additional expansions across different states for collaborative practice agreements where pharmacists work with doctors or other medical professionals for delivery of care. Rapid testing for UTIs, strep, the flu, and some of those things are starting to make their way through,” says Musselman.
Much of it has to do with how pharmacists are viewed by the industry, Musselman notes.
“Pharmacists are recognized as practitioners on the Medicare Part D side [drug coverage], but not on Medicare Part B, the medical service side, which limits access and reimbursement opportunities,” she says. “There needs to be that additional recognition, and we’re starting to see movement on this at the state level. There’s no federal designation, and that’s one of the biggest hurdles.”
The more organizations move to a value-based model versus pay-for-service the more this shift happens as well, Musselman notes.
A study in the Journal of Personalized Medicine in 2022 found that combining medication management with voluntary genomic testing to get a marker for how patients metabolize medications could lead to a $37 million reduction in cost.
“When you look at the various pieces, you have to balance the patient care and then the cost implications. You have to worry about staffing, and get all the right pieces to make it work: value, quality, and lower cost,” says Musselman.
Where change starts
Who needs to be involved to make this change in how pharmacists interact with patients? Perhaps the biggest hurdle is the government. There needs to be a National Provider Status, Musselman notes, and that will require Congressional involvement.
“We need pharmacists to be recognized as a provider by Medicare at the federal level,” she says. “And then there’s the payer side: adding pharmacists as an option for providing care. It moves from Medicare to commercial, and then you need to have leaders within the space step up. Finally, how are those additional stakeholders and providers going to come together to get the process moving?”
One profession can’t do it alone, she says. It requires lots of teams advocating for it.
The risks of not changing are clear, she notes.
“Medication is central to western medicine,” says Musselman. “You’re going to see higher cost of care, higher drug costs, more side effects, more moving pieces, lower quality of life, folks being admitted with side effects.”
From the patient perspective, having comprehensive medication management through a pharmacist can have a huge impact on their overall care.
“One of my favorite stories was having a patient referred to me who had boxes and boxes of herbal supplements and over-the-counter drugs at home. They needed help sorting through it and we found they had over 200 types of supplements,” says Musselman. “By the end of the first visit we were able to talk them down to 30, and a year later got them down to 10. It’s taking all those things that people are doing that they don’t want to tell anyone they’re doing and then being able to get it down to a manageable level.”
Another incident where pharmacist intervention worked involved a patient who was allegedly only taking three prescribed meds. But upon requesting to speak to a pharmacist, the patient explained they were actually taking seven herbal supplements and one was interacting with most of their prescribed meds.
“We have a lot of people who don’t disclose what they’re taking until they’re asked directly about herbals and supplements. You have to be a bit of a detective,” says Musselman. “I was doing a ride along with a nurse practitioner and we asked if they take any herbal supplements and the patient directed us to a cabinet full of supplements. You can ask patients to bring the meds out for you so you can get a look at them.”
If COVID-19 had one silver lining, it was the acceptance of telehealth to enable better access. Much of this medication verification and personal interaction can be handled remotely. Musselman has been on calls where she’ll ask to look at a medication the patient is taking on screen so she can verify in real time if it is interacting with other meds.
“You see what they do on their daily journey. They’re not coming to me polished, so I get to see them how they are,” says Musselman. “It’s a way to get a good idea exactly what they’re doing day to day.”
It can be eye opening for caregivers for aging patients as well who don’t know the right questions to ask the way a pharmacist will.
“They may not realize mom or dad is taking that medication. It becomes a dual conversation with the patient and the caregiver,” she says.
It doesn’t just end with asking patients the right questions, Musselman notes. Pharmacists need access to the right patient data to help them fully survey the medications a patient is on.
“The EHR is great for implementation but not everyone is connected. Pharmacists need to be able to check against the patient’s medication to determine if another option might work better,” she says.
Systems are less siloed than they used to be, but there is still room for improvement across the industry, however.
“Since I’ve been in this space there’s been a lot of change—a lot of advancement and a lot of acknowledgement about what a pharmacist can bring,” says Musselman. “I’d like to see that progress happening at a faster pace. Post-COVID, we’ve been thrown into a bit of a spiral with burnout and shortages, but there’s an opportunity to optimize the care team using all of our professionals at the top of their license, while keeping patients healthy and at home.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at email@example.com.