- In accountable care organizations (ACOs), fostering overall patient health requires high-touch patient wellness coaching. For ACOs facing the surmounting pressure to spark patient health behavior change, integrating pharmacists as another part of the clinician team is essential.
At Beth Israel Deaconess Care Organization (BIDCO), a physician- and hospital-owned value-based network and ACO, leaders understand that patient behavior change is a large hill to climb. Although essential to patient health – and the ACO’s financial health – patient behavior change is a lengthy process that requires multiple provider touchpoints.
A handful of provider visits each year will likely not help patients engage in regular healthy behaviors. Instead, ACO success relies on frequent and meaningful patient engagement, which will subsequently require the expertise of multiple care providers.
At BIDCO, ACO leaders are tapping the knowledge of area pharmacists. According to BIDCO chief medical officer Sarika Aggarwal, MD, the ACO’s “Pharmacy First” program has been key in improving the health of their diverse patient populations. Generally, the Pharmacy First program aims to:
- Monitor complex medication plans to increase likelihood of patient medication adherence
- Screen patients’ medications, results, and reactions to remove ineffective medications from the regimen
- Analyze patient prescription habits to help providers fine tune medication regimens
Pharmacists engage with patients and their primary care physicians for six to eight weeks to build a more dynamic patient relationship that could eventually spark patient behavior change, especially those related to patient medication adherence.
“We had pharmacists work in population health,” Aggarwal explained. “They took a target population that we identified by risk stratification. These included our diabetic patients whose conditions were out of control and who had gap measures. We had our pharmacists work with our providers, really on recommendations related to medication.”
But at the onset of the program, Aggarwal and her team knew they had to start small.
For example, because BIDCO serves such a diverse patient population – patients range from commercial Medicare beneficiaries, Medicaid patients, and dual-eligible patients – Aggarwal and her team decided to focus efforts on very narrow populations to test results. Specifically, the program targets patients with diabetes, COPD, CHF, asthma, or CVD.
The Pharmacy First program also started its focus on provider-directed interactions, as opposed to overhauling patient-provider interactions.
Much of the trouble with managing diabetes and other chronic illnesses is understanding which medication regimens work best for patients. While patients have a responsibility to take their meds, PCPs have a responsibility to understand and make applicable changes to a therapy so it will work well for the patient.
“We work with the providers and the PCPs who have varied knowledge with a lot of the new diabetic medications and comfort levels,” Aggarwal noted. “Pharmacists working with PCPs to get patients on the optimum medical therapy. That the first part was a very successful program.”
From there, Aggarwal and her team developed Pharmacy First to also include wellness coaching.
“The health coaching piece took a boot camp approach,” she said. “The idea worked to concentrate less on transforming behavior, although that was part of it. The primary goal was medication adherence as the pharmacists and providers had recommended, and enforcing any changes in medication. That was the first piece.”
Pharmacists also focused on different aspects of patient self-efficacy, Aggarwal added. These elements of patient education helped to make a self-sufficient patient who was able to recognize when health concerns were cause for intervention or when symptoms could mitigate themselves.
“The second piece was really having the patient understand the symptoms and signs of complications with their disease, as well as the sort of knowing when to call,” Aggarwal explained. “This adds up to self-management skills related to that.”
Pharmacists are increasingly recognized as essential partners in patient wellness, especially in the value-based care landscape. Pharmacists add another touchpoint for patients and can focus on a different set of patient needs that may not be applicable in the clinic exam room.
There is also a community benefit of pharmacist patient engagement. Many patients visit their neighborhood pharmacist who might prescribe and issue medications out of a local convenience store. This creates a comfortable environment that allows pharmacists to build positive rapport with the patient and gain patient trust, two essential components of effective wellness coaching.
For the specific populations BIDCO has focused on, the pharmacist makes sense as a care partner. While conditions such as diabetes and heart disease must be managed by a healthy diet and active lifestyle, there is also a significant medication component to it.
“While the self-management behavior, the diet, the exercise, and the treatment adherence are big parts of wellness, medication also plays a large part,” Aggarwal pointed out. “There’s almost no patient who is well established within the disease process who can do without medication. Pharmacists therefore are uniquely situated in this process, because they understand the medication piece of it very well.”
Because of their deep knowledge, pharmacists are an essential cog in population health management.
“Pharmacists add to the population health management going forward, because we need an army of people,” Aggarwal added. “We cannot just have providers doing population health management. We need other members of the work force.”
Healthcare organizations across the country have taken a similar approach with pharmacists conducting patient outreach. Healthcare organizations are leveraging pharmacy professionals for patient education, medication adherence interventions, and other chronic disease management work.
“Medication management treatment is rapidly progressing,” Aggarwal concluded. “In the future, pharmacists are going to be playing an important role as independent practitioners. This is the beginning of a pathway where, just as we have nurse practitioners, we’re going to have to see pharmacists as independent practitioners.”