Evaluation of Pharmacists’ Work in a Physician-Pharmacist Collaborative Model for the Management of Hypertension
Physician-pharmacist collaborative models have been shown to improve the care of patients with numerous chronic medical conditions. Team-based healthcare using integrated clinical pharmacists provides one opportunity to improve quality in healthcare systems that use population-based financing. In November 2015, the Centers for Medicare and Medicaid Services (CMS) requested that the relative value of pharmacists’ work in team-based care needs to be established. Thus the objective of this study was to describe the components of pharmacists’ work in the management of hypertension with a physician-pharmacist collaborative model.
Descriptive analysis of the components of pharmacists’ work in the Collaboration Among Pharmacists and Physicians to Improve Outcomes Now (CAPTION) study, a prospective, cluster randomized trial.
MEASUREMENTS AND MAIN
This analysis was intended to provide policymakers with data and information, using the CAPTION study model, on the time and intensity of pharmacists’ work to understand pharmacists’ relative value contributions in the context of CMS financing and population management aims. The CAPTION trial was conducted in 32 community-based medical offices in 15 U.S. states and included 390 patients with multiple cardiovascular risk factors. Blood pressure was measured by trained study coordinators in each office, and patients were included in the study if they had uncontrolled blood pressure. Included patients were randomized to a 9-month intervention, a 24-month intervention, or usual care. The goal of the pharmacist intervention was to improve blood pressure control and resolve drug therapy problems impeding progress toward blood pressure goals. This intervention included medical record review, a structured assessment with the patient, collaboration to achieve goals of therapy, and patient follow-up. The two intervention arms (9 and 24 mo.) were identical the first 9 months, and that time frame is the focus of this workload evaluation. Pharmacists completed study encounter forms for every patient encounter and estimated time spent in pre-visit, face-to-face care, and post-visit activities. Among the 390 patients, there were 2811 encounters with pharmacists that involved 3.44 hours/patient for face-to-face care visits plus 1.55 hours/patient for pre-visit and post-visit work. Intensity of work was reflected in interventions to resolve drug therapy problems with patients (43% of encounters) and with physicians (1169 recommendations, of which physicians accepted 1153 [98.6%]), resulting in improvement of patients’ blood pressure goals achieved (from 0% at baseline to 43% at 9 months based on the primary study end point).
Pharmacists provided extensive interventions to patients with hypertension. This analysis provides a framework for health systems, provider groups, and payers to measure pharmacists’ work in value-based financing and population management.
Overview of article
- The objective of this study was to describe the components of pharmacists’ work in the management of hypertension with a physician-pharmacist collaborative model
Methods of article
- Descriptive analysis of the components of pharmacists’ work in the Collaboration Among Pharmacists and Physicians to Improve Outcomes Now (CAPTION) study, a prospective, cluster randomized trial
- Results of this analysis can be applied to stating the value proposition of pharmacist integration in new care delivery and financing models. The body of evidence in the value proposition suggests that pharmacist and physician collaboration in team-based care has the ability to positively impact national aims of better care, better health, and smarter spending
- As health insurers continue moving toward Centers for Medicare and Medicaid Services (CMS) payment taxonomy categories 3 and 4, sustainable compensation models for pharmacist practitioners will likely include a combination of population-based payments to the healthcare team or organization in which they are employed
- This analysis will be valuable as accountable care organizations (ACOs) and integrated care teams develop more efficient and effective interprofessional working relationships to deliver improved care. Legislators are evaluating implementation of CMS Medicare Part B provider status for pharmacists within Medicare and Medicaid programs. If Congress authorizes pharmacist provider status, this analysis may be beneficial in the process of determining the value of medication therapy management (MTM) services provided by pharmacists, consistent with processes utilized by the current procedural terminology (CPT) Relative Value Scale Update Committee