Enhanced Pharmacy Services: Improving Outcomes for Patients with HIV

A clinic sees improved viral suppression rates as a result of comprehensive medication review, medication synchronization, and patient outreach services.

HIV infection rates are skyrocketing in the American South. According to the Centers for Disease Control and Prevention, 75% of the cities with the highest rates of new HIV infections per capita are located in southern states.¹ Even more alarming is the fact that nearly half of the patients who are diagnosed with HIV at Grady Hospital in Atlanta, the top city in the United States for new HIV cases, already has AIDS the day they test positive for HIV.²

The goal of any HIV therapy is to suppress viral loads to undetectable levels, but the urgency to do so is amplified in 2 subgroups: patients who are diagnosed with AIDS and those who are coinfected with other diseases. Both of these scenarios are more common in patient populations that face demographic, geographic, and financial barriers to treatment access and medication adherence.

The 1917 Clinic, a Ryan White grantee at the University of Alabama at Birmingham, serves a large patient population that struggles with adherence. University clinicians recently completed analysis of 652 HIV patients over a 38 month period who received enhanced pharmacy services from Curant Health as part of their treatment plans. Of the 157 patients who did not have suppressed viral loads at enrollment, 103 achieved viral suppression during follow-up tests, which ranged from 6 weeks to 1 year after enrollment.³ That’s a statistically significant increase in the proportion of patients achieving viral suppression.

These results serve as a model for patients suffering from a variety of chronic disease states because Medicare has started to shift away from its decades old sustainable growth rate formula toward a new model of value-based care, including the already implemented Value-Based Modifier Program.⁴ Favoring the overall value of health care administered rather than reimbursing based on activities and treatments alone, the nation’s largest health insurer⁵ is encouraging providers at every level of the health care system to put a renewed emphasis on patient outcomes.

The improved outcomes achieved through suppressed viral loads in this sample are attributed to the enhanced pharmacy services provided to each patient. These services expand the role of the pharmacy staff in 3 ways to remove roadblocks to adherence and provide better outcomes:

• Comprehensive medication review. Curant Health pharmacists reviewed the medications taken by each patient to eliminate interactions and unintended side effects, aligning with clinic staff to arrange substitute therapies when necessary. It is vital that this step is conducted by pharmacists who are up-to-date on the most recent data on breakthrough medications so that potential drug—drug interactions are avoided and the best alternative medications are used to minimize health risks and side effects.
• Medication synchronization and home delivery. In partnering with the 1917 Clinic, Curant Health pharmacists strove to provide comprehensive medication management by filling all patient medications. This approach facilitates medication synchronization, which, for the patient, means that all refills arrive on their doorstep at the same time each month. In addition, patient medication can be delivered in adherence packaging that simplifies medication for patients on multiple therapies by grouping all medications in individual pouches that are sorted by date and time of day to be taken. This approach to synchronized home delivery of all medications drives adherence in multiple ways. Ensuring medication never runs out and that all necessary drugs are supplied in single-dose packs to the patient’s home can remove known adherence barriers related to lack of convenience/ease of refill, transportation, and possible social stigma.
• Routine patient outreach and follow-up. Patient care coordinators (PCCs), all licensed pharmacy technicians from Curant Health, reached out to patients by telephone at regular intervals to proactively check for adherence. PCCs were empowered to identify and assist in addressing barriers that inhibit adherence and helped eliminate these roadblocks. PCCs form candid relationships with patients that are often difficult to achieve in a clinical setting, and they serve as motivators to encourage patients to remain adherent.

The impressive outcomes achieved by the 1917 Clinic in suppressing the patient HIV viral loads in this recent study are the direct result of the clinic’s partnership with an innovative medication management company that has implemented enhanced pharmacy services to address medication adherence issues and to educate, motivate, and advocate for patients. These value-added services drove the therapy adherence necessary to accomplish this increase in suppressed viral loads and ultimately, better outcomes.

Services offered by medication management partners, like the ones used in this patient group, are representative of the enhanced role pharmacy staff can play in health care. Medication management can achieve similar results in a wide variety of patient populations and should be considered for implementation in any patient set suffering from a chronic disease. As health care becomes more value-driven, look to medication-management partners to help provide the outcomes sought by patients, payers, and manufacturers.

The Bigger Picture: Extrapolating For Value

Suppressed viral loads are the gold standard for measuring HIV patient outcomes because they reduce hospital stays and improve quality of life; however, the model goes far beyond HIV itself. Many patients infected with HIV are coinfected with other chronic diseases or struggle with conditions that cannot be treated effectively until HIV viral loads are suppressed. In HIV patient populations, controlling the virus is the gateway to improving outcomes on all fronts as it opens the door to expanding treatment.

Beyond HIV, this kind of program serves as a larger model for chronic disease states of all kinds like diabetes, Crohn’s disease, and hypertension. Improving outcomes for these patients has immediate impact on providers as they file claims with Medicare and begin navigating the initial phases of the new value-based structure of the program, which will expand in the coming years.

The notion of value-based health care is also likely to expand to private insurers as efficiencies from Medicare’s rollout become apparent. Although individual metrics and formulas will vary, the fundamental equation of Value = Outcomes/Costs is likely to permeate most, if not all, payers.

Whereas, value-based reimbursements represent a new paradigm in the traditional insurance model, only half of the equation is new. Controlling costs has long been a mainstay of treatment. However, measuring those costs relative to outcomes, instead of in a vacuum, is intended to impact costs over a longer time frame while bringing patients to the forefront of the health care system.

Through frontline communication with patients and expert knowledge in pharmacology, pharmacists and pharmacy staff have a unique opportunity to impact the outcomes portion of value-based health care through expanded offerings like enhanced pharmacy services and medication therapy management. This notion extends to other partners in health care as well, such as medical technology solution providers, equipment manufacturers, pharmaceutical manufacturers, and clinicians.

All of these entities can expect increased opportunities and motivations to work together in the future to improve patient outcomes. The ones that will emerge the most successfully are those with the strongest resolve to put patients at the forefront of all operational activity. SPT

References

• Reynolds D. The 25 cities with the highest rates of HIV infection. HIVPlus. Published September 22, 2014. www.hivplusmag.com/just-diagnosed/2014/09/22/25-us-cities-highest-rates-hiv-infection.
• Hagen L. Half of Atlanta’s newly diagnosed HIV patients have AIDS, Grady testing finds. WABE 90.1 FM website. Published March 20, 2015. http://wabe.org/post/half-atlantas-newly-diagnosed-hiv-patients-have-aids-grady-testing-finds.
• Rutland W, Tamhane A, Mugavero M, et al. Antiretroviral prescription delivery for persons living with HIV/AIDS in Alabama: do mailed medications with enhanced pharmacy services affect biologic outcomes? Presented at: IAPAC 10th International Conference on HIV Treatment and Prevention Adherence; June 28-30, 2015; Miami, FL. http://iapac.org/AdherenceConference/presentations/ADH10_OA205.pdf.
• Centers for Medicare & Medicaid Services. Fact sheet. Published April 2015. www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Attribution-Fact-Sheet.pdf.
• Centers for Medicare & Medicaid Services. CMS press toolkit. www.cms.gov/Newsroom/PressToolkit.html. Published May 17, 2013.

About the Author

Marc O’Connor is chief operating office for Curant Health, a provider of enhanced medication therapy management and specialty pharmacy services proven to improve patient outcomes and reduce total health care spending. Marc is also a board member of the Team Type 1 Foundation, an organization whose mission is to “instill hope and inspiration for people around the world affected by diabetes.”