Essential hospitals that strategically integrate pharmacists into ambulatory care settings — an expanding practice nationally — are seeing benefits, including reduced burnout among caregivers, better medication adherence, and improved patient experience and access to care.
Enabling pharmacists to provide clinical care for patients within the scope of their role holds promise for even greater rewards: Virginia Commonwealth University (VCU) found pharmacists could save millions of lives and more than $1 trillion in health care costs over 30 years if they were empowered to coordinate care and help patients manage chronic conditions.
By integrating pharmacists into ambulatory settings — especially ambulatory specialty care — hospitals can overcome challenges facing health care systems and the people they serve, and achieve these outcomes:
Integrating pharmacists, liaisons, and technicians into the ambulatory care team adds knowledgeable clinical staff and frees other health care workers to practice at the top of their license. It also can ease workforce shortages, as these elevated roles are highly sought-after positions with large pools of applicants hoping to find improved work environments. Pharmacy liaisons in an ambulatory setting can focus on patients’ access to medications, providing the necessary help they need to navigate insurance coverage, financial assistance, and access to therapy. This improves the working environment by relieving the burden on the medical staff and lessening burnout.
A case in point: prior authorization (PA) approvals. Data show physicians and staff spend an average of 16.4 hours a week completing PA requirements for prescriptions and medical services, and that 35 percent of physicians dedicate staff to prior authorization. The lengthy time it can take to obtain specialty prescription PA is well documented — an average of nearly 21 days for a provider’s office, according to one recent study.
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Pharmacy liaisons excel in PA efficiency, ensure short turnaround times, and can pull in needed information to simplify the process for the clinic. My company, Clearway Health, partners with health systems to provide PA support by leveraging clinic-embedded and remote patient liaisons. These liaisons investigate benefits available to patients who are newly prescribed specialty treatment, evaluate their financial assistance needs, submit PA approval requests to health plans, and manage initial and renewal authorizations. The Regulatory Relief Coalition reports that prior authorization wait times can be lengthy — from two to 14 days for three-quarters of physicians and, for 15 percent, 15 to 31 days. Clearway Health achieved a turnaround time of 1.8 days or less for more than 9,500 patients at OU Health, an essential hospital in Oklahoma City, Oklahoma.
Hospitals also have started using pharmacists for direct patient care in the clinic through traditional nursing duties, such as administering medications. Working with a specialty pharmacy accelerator can help health care systems determine the most effective ways to offload secondary workload burden and allow clinical staff to practice at the top of their license, focusing on what is most important: the patient.
In the United States, about 20 to 30 percent of new prescriptions written are never filled at a pharmacy, and of those that are filled, only about half are taken as prescribed. Most patients who are prescribed medications for chronic conditions take less medication than prescribed after six months or stop taking medication altogether. The reasons for poor medication adherence are varied but include forgetfulness, discomfort from side effects, misunderstanding dosing directions, and other factors. Cost also can play a large role, especially for drugs to treat complex and chronic conditions, such as multiple sclerosis and cancer — medications that can cost $5,000 or more a month and come with hard-to-navigate health plan coverage requirements.
Enter the ambulatory care pharmacist, who can improve adherence with tools not available in the retail pharmacy setting — for example, access to the health system’s electronic health record — and by directly communicating with the care team and patients (especially important for the laborious task of receiving prior authorization approval for prescriptions). With this expanded role, the pharmacist can help a patient understand medication regimens, manage side effects, and plan for and comply with refills.
But the benefits of an expanded role for pharmacists do not end there. Their access to specialized technology allows them to create value-based care experiences; identify patients eligible for specialty pharmacy programs; drive efficiency by using clinical, claims, and referral data to inform clinical operations; fulfill prescriptions; improve patient outreach; and grow a health system’s revenue margin, without which revenue has limited value for the system.
Important to this strategy is managing patient panel capacity — the number of patients for whom an ambulatory pharmacist cares — by surveying patient, provider office, and medical staff needs. Awareness of managing patient panel responsibility and the work pharmacists and specialty pharmacy patient liaisons contribute is important to avoiding burnout.
When pharmacists practice patient-centered care, they can increase the number of patients who experience optimal outcomes by 41 percent, reduce the cost of drug-related illness by almost 60 percent, and contribute to almost 120,000 lives saved per year, VCU found.
Patient-centered care often means supporting informed decision-making. By helping patients understand and navigate ambulatory specialty care, pharmacists can mitigate emergency department visits and inpatient stays and, in turn, reduce unnecessary adverse events and readmissions. Further, they can help hospitals avoid unnecessary care costs by providing follow-up care to make sure patients are monitored for symptoms and take their medications on time.
Integrating pharmacists into the ambulatory care setting has clear benefits for essential hospitals. However, each health system has unique needs and must carefully define pharmacists’ role. It is critical to work with physicians, other providers, and staff to discuss clinic workflows and identify gaps in care. Open communication allows productive working relationships among all care team members and fosters an environment in which creative solutions for clinical burnout, staffing, and improved patient access to care succeed.
To read the full published article in America's Essential Hospitals' blog, Essential Insights, click here.