Chronic Care Management: An Emerging Opportunity for Pharmacists

Clifton, Cody L.; Phillips, Andrea; Abubakar, Amina

doi:10.4140/tcp.n.2018.611.

Cited by 5 publications

(7 citation statements)

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“…However, no data were found on collaboration between physicians and community pharmacists. Researchers discussed how CCM services pose an opportunity for community pharmacists to partner with billable health care providers, as this service aims to improve the quality of patient care as well as providing extra revenue for pharmacists …”

Section: Discussionmentioning

confidence: 99%

“…To standardize and incentivize CCM, the Centers for Medicare and Medicaid Services (CMS) introduced the CCM reimbursement system . CMS considers CCM an integral part of primary care that positively impacts patient health outcomes and quality of care; this initiative came to connect the fee‐for‐service and value‐based models. The major elements of CCM include a systematic assessment of the patient's medical, functional, and psychosocial needs, followed by an approach that ensures all recommended preventive services are received.…”

Section: Introductionmentioning

confidence: 99%

“…Researchers have discussed the role of pharmacists in delivering CCM in various settings. Community pharmacists may be particularly useful because of their regular interactions with patients associated with prescription dispensing . One of the few studies to examine the role of clinic‐based pharmacists is by Fixen and colleagues .…”

Section: Introductionmentioning

confidence: 99%

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Community pharmacist and family medicine clinic provision of chronic care management services for Medicare beneficiaries with uncontrolled hypertension

Witry

Al-Khatib

O'Brien

et al. 2020

J Am Coll Clin Pharm

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Introduction: Pharmacist-physician collaboration has shown positive results in improving patient outcomes. Chronic care management (CCM) is a reimbursable service for Medicare beneficiaries in the community setting which includes comprehensive care management and other activities. The pharmacist contribution to CCM services and their associated impact on patient health outcomes has not been fully explored.Objectives: The objectives of this study were to: (a) implement a collaborative CCM service between a community pharmacy and family medicine clinic for their common hypertensive patients; (b) measure blood pressure change for patients receiving the CCM intervention; and (c) report financial viability for the community pharmacy and family practice clinic partnership.Methods: Single group prospective pilot intervention in an independent community pharmacy and family medicine clinic in a small city in the Midwest United States.Forty-five patients with uncontrolled hypertension who are patients to both community pharmacy and clinic were recruited, and 26 received CCM interventions in person or over the telephone from the community pharmacists to manage medications for hypertension. Our main outcomes were blood pressure values and financial viability.Results: Twenty-six patients received at least one community pharmacist encounter.These patients had an average 7.3 mm Hg decline (P = .006) in systolic blood pressure (SBP) and a 2.4 mm Hg decline (P = .079) in diastolic blood pressure (DBP) at 9 months. The total revenue over the study period was $5842. Total revenue for the community pharmacy and clinic was $2785 and $3057, respectively. Conclusion:The community pharmacy/clinic collaboration resulted in improved blood pressure control, a new source of revenue for the community pharmacy, and increased revenue for the clinic. Further research is needed on CCM revenue sharing between physicians and pharmacists to generalize the results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Community pharmacist and family medicine clinic provision of chronic care management services for Medicare beneficiaries with uncontrolled hypertension

Witry

Al-Khatib

O'Brien

et al. 2020

J Am Coll Clin Pharm

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“… 49 Pharmacists provide chronic care management services (i.e., services aiming to improve health outcomes by enhancing care coordination for patients with multiple chronic conditions) to Medicare beneficiaries, reimbursable since January 2015 via the Medicare fee-for-service program. 50 The goal is to help the primary clinic achieve the quality measures set by CMS, while also arranging a way for both parties (physician and pharmacists) to be reimbursed, even if billing is under the physician’s fee schedule. This model is by no means widespread in the US and requires collaboration with a provider.…”

Section: Community Pharmacy In the Usmentioning

confidence: 99%

“…This model is by no means widespread in the US and requires collaboration with a provider. 50 Primary care is also moving inside pharmacies. Several community pharmacy chains and mass merchants have opened walk-in clinics inside their stores as a means to increase access to care.…”

Section: Integration Of Community Pharmacy and Primary Carementioning

confidence: 99%

Primary healthcare policy and vision for community pharmacy and pharmacists in the United States

Salgado¹,

Rosenthal²,

Coe³

et al. 2020

Pharm Pract (Granada)

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The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges.

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Barriers and best practices related to documentation of electronic care plans: A survey of community-based pharmacies in 4 states

Baggett

Dorval

Ballou

et al. 2022

Journal of the American Pharmacists Association

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Chronic Care Management: An Emerging Opportunity for Pharmacists

Cited by 5 publications

References 0 publications

Community pharmacist and family medicine clinic provision of chronic care management services for Medicare beneficiaries with uncontrolled hypertension

Community pharmacist and family medicine clinic provision of chronic care management services for Medicare beneficiaries with uncontrolled hypertension

Primary healthcare policy and vision for community pharmacy and pharmacists in the United States

Barriers and best practices related to documentation of electronic care plans: A survey of community-based pharmacies in 4 states

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