Healthcare Reform Has Potential to Improve Pharmacist-Patient Relations

October 29, 2009 — Editor's note: Edwin Webb, PharmD, MPH, is associate executive director of the American College of Clinical Pharmacy (ACCP), the national professional society that represents more than 10,000 clinical pharmacist practitioners, researchers, and educators. For the past 30 years, ACCP leaders and members have worked to strengthen ties among pharmacists, patients, and clinicians by advocating for clinical pharmacy services, patient and practitioner consultation, pharmacotherapy research, and educational programs that promote better use of medications over the broad range of settings in which clinical pharmacists practice. In April, Dr. Webb testified before the National Advisory Council for Healthcare Research and Quality on the importance of comparative effectiveness research. On the eve of the ACCP's annual meeting in Anaheim, California, he spoke with Medscape Pharmacists about clinical pharmacists and healthcare reform.

Medscape: What are some of the ACCP's biggest concerns about the issues being raised in the current debate about healthcare reform?

Dr. Webb: We see healthcare reform as a great opportunity to advance the case for pharmacists' direct involvement in patient care. The ACCP has been working individually and with other pharmacy organizations and coalitions to improve the use of medication through pharmacists' services in all of the major healthcare reform proposals that have been floated. We've been reasonably successful. All of the bills that are attracting most of the headlines and attention have, to some degree, elements of the changes we believe are important: to bring pharmacists and patients closer together and to promote more collaboration between pharmacists and other members of the healthcare team. Some of the legislative language may not be as specific as the ACCP might like, but the fact that it's in all of the legislative proposals in one form or another makes us cautiously optimistic that something positive will result.

Medscape: What do you think are the most important proposed changes?

Dr. Webb: The bill that came out of the Senate Health, Education, Labor and Pensions committee and the bill that is currently under consideration by all 3 committees of the House of Representatives both have provisions that would support the concept of pharmacists' clinical services in the medical home model, a big element of healthcare reform that has received a lot of attention. One of the Senate bills would initiate a grant program to establish community health teams, including access to pharmacist-delivered medication-management services. Another section of that bill would provide funding for grant programs to implement medication-management services as collaborative interprofessional services in a team-based approach to managing chronic diseases for targeted individuals. Those are 2 provisions that are consistent with the efforts we've been making for many years to reform the Medicare Part B payment rules that provide for payment for physician and nurse practitioner services. We would like pharmacist services to be recognized under that provision.

Team-based care that focuses on improved medication use and outcomes and preventing medication-related problems can work, but the current payment methodologies, with fee-for-service and all the providers isolated in their own practices, having no incentive to work together as a team, make that type of practice pretty difficult, particularly in community settings, even though these kinds of services have been working effectively in hospitals and managed-care organizations for a long time.

Medscape: How does this fit with the concept of the medical home model?

Dr. Webb: Traditionally, time spent with patients that is not procedure-based, such as visits to primary care physicians, nurse practitioners, or physician assistants, is not terribly well rewarded in our current fee-for-service structure. So healthcare reform, from the physician's perspective, has been around this concept of the medical home model and changing reimbursement strategies to pay for a more blended approach that includes not only fee-for-service with individual contacts, but also maintenance payments for taking on a family or individual and providing all of their care and coordination, not unlike what some of the managed-care organizations do.

Among the tenets of the patient-centered medical home model is that care is continuous and comprehensive and involves more than just the physician; it involves other providers and behavioral health services. We are just on the cusp of convincing people that medication management is an important part of that comprehensive service model. The legislation supports the concept that people who are trying to develop medical home models would be given incentives to include medication management and pharmacists' services as part of the basket of services that they provide to their patients.

Medscape: How will health information technology help the ACCP achieve its goals?

Dr. Webb: A big part of healthcare reform involves support for electronic medical records, electronic data interchange, and interoperability of healthcare systems. What that will help achieve, by including everyone who is taking care of the patient, is a shared understanding of what's going on with the patient, what the patient's problem is, the lab tests the patient has undergone. . . . So a big part of the importance of healthcare reform, from our perspective, is policymakers beginning to embrace the notion that, to accomplish team-based care, we've got to do some fundamental restructuring of the health information system, so that the team is paid for the care, not the individual practitioner.

All of this will not be accomplished in a single healthcare reform bill in 2009 but, as the White House keeps saying, you've got to start somewhere.