When a patient is engaged in the home by a team that includes a pharmacist resource, social determinants of health issues become more clear and the care team can help close the gaps.
There are an estimated 275,000 deaths and $528.4 billion wasted annually in the United States due to inaccurate prescribing, medication errors, adverse drug reactions, skipped doses, or treatment failures. This is specifically a concern for seniors, given that nearly 9 in 10 are on at least 1 medication, with the majority being prescribed multiple medications.
The current model for medication management is not sufficient to close these gaps and improve patient outcomes. What’s required is a more holistic approach in which pharmacist expertise is integrated into a multidisciplinary primary care team.
Comprehensive medication management (CMM) is an approach that ensures each patient’s medications are individually assessed to determine that each is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended. This whole person model not only saves lives by addressing the factors that lead to poor patient outcomes, but it also improves health plan ROI by as much as 12:1 according to some estimates.1
CMM examines not only prescriptions but OTC drugs, supplements, herbals, and nutraceuticals as well. Working with a primary care physician as the quarterback of an integrated team, the CMM model can assist with care coordination and as a point of reference for patients and their providers. It provides a source of truth for each patient’s medication regimen.
This can lead to earlier identification of adverse effects (AEs) and drug interactions, as well as reducing medication errors while boosting the likelihood that patients will successfully take medications as prescribed.
The benefits of investing in CMM are plentiful. Here are 3 specific scenarios in which this holistic, hands-on approach to medication management can offer a meaningful and direct impact.
Many older adults are impacted by AEs from medications. If left unchecked, this often leads to a prescribing cascade. A patient starts taking a medication for a health concern and that medication produces an AE, which triggers another prescription to deal with the AE.
It snowballs from there, in some cases resulting in 10 or even 20 prescriptions stemming from the initial medication. This is among the many common issues a CMM model will catch and address, bringing benefits to the patient and the health plan.
STAR ratings for many health plans have dramatically declined in the past year, particularly when it comes to medication adherence. We have seen a decrease in the percentage of patients who are properly taking medications.
In some cases, patients are simply not taking medications as prescribed, but in other cases the issue is timely access and an ability to show up for physician appointments or fill prescriptions. This is the perfect use case for how a CMM model can drive both financial and clinical improvements for a health plan.
Another huge opportunity with a CMM approach is addressing health equity. In many cases, social determinants of health (SDoH) are responsible for patients not successfully following their medication regimens.
Patients won’t always admit to a physician that they can’t afford a medication or that there are other obstacles to their adherence with medication plans. Instead, they pretend they are going to fill the prescription or that they are taking a medication as prescribed. When a patient is engaged in the home by a team that includes a pharmacist resource, SDoH needs bubble to the surface, and the team can help close the gaps.
One of our patients had uncontrolled blood pressure—running into the 200s—even though she reported taking all related medications as prescribed. This particular patient was taking 30 different medications, including prescriptions, OTC products, and herbal supplements.
Upon review of this expansive medication list, we discovered that one of her prescriptions was interacting with the blood pressure medications she took in the morning and evening. As a result, she wasn’t getting the benefits of those medications, which explained why her blood pressure was trending in the wrong direction.
Her pharmacist worked with the care team to adjust and optimize her medication regimen. It took less than 24 hours to bring her blood pressure down and reduce the potential of her making an unnecessary trip to the emergency department.
Within 72 hours, her readings were significantly reduced and in an acceptable range. Over time, we were able to safely eliminate the medication that was causing all the problems in the first place. If the pharmacist resource from her care team had not solved the riddle, this patient could have experienced a stroke or other adverse health event.
We are making great strides as an industry when it comes to CMM. Specifically, at Emcara Health, we have invested in advancing our capabilities to be more proactive and strategic in our support of medication needs across our patient population. For example, instead of waiting for a list of patients who have run out of pills or haven’t completed their latest refill, we leverage multiple data sources to identify and prioritize which patients have a medication-related care gap and would benefit from proactive outreach.
Even with the benefits associated with CMM, there are barriers to widespread application of the CMM model. To fuel the growth and adoption of CMM, we need alternative payment models to incentivize these activities by reimbursing for specific services provided by pharmacists.
Also, the recognition of pharmacists as providers is important. As an example, even though pharmacists have the appropriate training, background, and experience, they are not recognized as providers within Medicare Part B. Recently, several states have decided to recognize pharmacists as providers for Medicaid, which is a trend that needs to continue.
Finally, we need to see more buy-in from health plans to fund CMM as part of their care management initiatives. Some progressive plans are fully engaged, whereas others are lagging behind.
Most physician groups are not equipped to integrate pharmacy programs into their practice, so CMM is an approach that must be embraced and funded. Health plans are in the best position to invest in CMM, particularly as part of an integrated approach for delivering care to members’ homes. As more value-based models are being implemented across the industry, there are increasing opportunities to fold in CMM to more holistically support patients.
About the Author
Kerri Musselman is vice president of Pharmacy Care Solutions at Emcara Health.
1. Barr M, et al. Comprehensive medication management: A missing ingredient in value. Health Affairs. Published September, 9, 2022. Accessed July 10, 2023. https://www.healthaffairs.org/content/forefront/comprehensive-medication-management-missing-ingredient-value-based-payment-models.