The Appointment-Based Model: A Catalyst for Expansion of Services

MAY 18, 2015
Rebecca W. Chater, RPh, MPH, FAPhA
An efficient pharmacy system allows pharmacists the time to provide valuable patient care services.
Although the appointment-based model (ABM) is frequently cited within the context of medication synchronization as a cornerstone for improving adherence, the efficiencies inherent in the model also afford pharmacies the time and resources to drive quality improvement through the delivery of many other highly valuable patient care services. Using the ABM, pharmacies are able to deliver high-quality, cost-effective, patient-centered care to meet the demands of a changing health care landscape and ensure the sustainability of community pharmacy practice.

Quality Improvement
According to the Institute of Medicine, the United States’ recognized advisor on health care improvement, the quality of an organization is measured by the direct correlation between its health care services and desired health outcomes of individuals and populations. To improve quality, organizations must incorporate 4 key principles: systems approach, patient focus, team-based care, and data utilization.1 The ABM encompasses these 4 elements:
  • Systems approach. Structured proactive patient contact in advance of the monthly patient visit, informational patient-level review and planning, and pre-visit contact with the patient to confirm objectives for the monthly patient visit are provided.
  • Patient focus. The ABM shifts focus from prescription transactions to the holistic assessment of patient medication and health care–related needs. These needs are addressed longitudinally by virtue of multiple monthly touch points in preparation for pharmacist–patient engagement at the monthly visit.
  • Team-based care. The ABM positions pharmacy to provide a broader mix of patient care services and improve the coordination of care required to function as an active member of the health care team.
  • Data utilization. Central to the effective ABM is technology that provides actionable data for efficient identification of patients on whom the pharmacy should focus and the necessary interventions/ services that the pharmacy should provide.

The Changing Health Care Environment
Unsustainable health care costs continue to drive an intense focus on value.2 Health care quality, safety improvement, and cost reduction have become health care imperatives.3 Health plans and health care providers are assuming increasing levels of risk. In order to navigate successfully, they are aligning with new partners, utilizing more data in different ways, and prioritizing value in health care decision making.2 In addition, the aging US population and tremendous advances in health care technology have continued to increase the demand for pharmacy services.3

According to a 2014 report, Exploring Pharmacists’ Role in a Changing Health Environment, increased health care costs have typically not resulted in quality improvements: they may be related to inefficiencies and variation in care delivery. The Joint Commission of Pharmacy Practitioners’ 2014 publication, The Pharmacists’ Patient Care Process, underscores the need to minimize inefficiency and variation by advocating for a standardized patient-centered pharmacy process in a collaborative, team-based approach with other health care providers to optimize patient health and medication outcomes.4 The ABM affords pharmacy a framework within which to achieve the standardization and efficiency required to not only tackle nonadherence, but also improve health care quality and decrease related costs.

Greater access to data yields information that can facilitate quality improvement, cost savings, and collaboration among providers. To benefit from this data, pharmacies need technology and data analytics to not only access the information, but to filter actionable information from noise in order to capitalize on 3 trends that are shaping the health care market today2:
  • Health plans are seeking savings through partnerships, integration, and provider risk sharing.
  • Providers are focused on higher value service delivery, coordination of care, and team-based collaboration
  • Patients are more engaged due to improved access to health plan and provider ratings, true costs of care, and their own health care information.