The Advisory Board Company is a research, technology, and consulting firm with longstanding and deep relationships in Washington, DC.
The Advisory Board Company is a research, technology, and consulting firm with longstanding and deep relationships in Washington, DC. The firm is arguably one of the most influential companies in the health care space, has a very loyal health-system member following, and has access to most of the top health care executives across the country.
In the past few months, The Advisory Board has posted interviews, provided briefs, taken questions, and published infographics about the increasingly important and emerging role of the pharmacist. Advisory Board’s publications “6 Ways Your Pharmacist Can Save the Day”1 and “Why You May Already Have a Population Health ‘Secret Weapon’—and not Even Know It2 speak to how pharmacists’ skills and training, when repositioned or reemphasized in the care team, may align well with payment reform and the emerging outcomes marketplace. Here is an excerpt:
There are all kinds of great data that show pharmacists can reduce medication errors, reduce readmissions, and provide the support patients need to follow through on their medication regimens … What is new is the current regulatory environment. In a fee-for-service environment, there’s no reimbursement for pharmacists’ time. But now, in a population health world, all of these factors have financial value.”1 —Lindsay Conway, Advisory Board
More Important Voices
The National Governors Association (NGA) is a nonpartisan organization that facilitates policy development and provides assistance to state administrators and their staff. Early last year, NGA produced a document that encouraged states to consider a more concerted look at expanding the role of pharmacists beyond dispensing. It suggested that removing barriers to pharmacists’ ability to apply their clinical acumen as medication-use experts would liberate them to contribute greatly in a modernized system of care. An excerpt regarding this follows:
The critical role that medication management plays in treating chronic diseases suggests that the integration of pharmacists into chronic-care delivery teams has the potential to improve health outcomes. 3 —NGA
Leavitt Partners just released a brief, “Defining High-Value Pharmacists for ACO [Accountable Care Organization] Partnerships,”4 that outlines how, and with whom, to partner if you are an ACO looking for help from pharmacists and pharmacies. An excerpt reveals how pharmacists helping other entities produce outcomes is becoming socialized widely:
As ubiquitous and potentially frequent touchpoints in most health care markets, ACOs can leverage pharmacists to help patients of all types better understand their medications, remind them to re-connect with their primary care provider, or encourage preventive care like vaccinations or screenings. —Leavitt Partners
The Audience Is Just as Important as the Message
What’s notable about these publication efforts isn’t the substance of what they are saying. Countless articles about the value of the pharmacist are in circulation. As a profession, we’ve published tomes of materials for pharmacist consumption that essentially state the same. However, now a new audience is emerging, and it isn’t from our own ranks. It’s from an external environment taking a critical look at the necessary structures and human resourcing of the new system of care delivery that will form over the ensuing decades.
Held to a Different Standard for Decades, Pharmacists Are Now Well Positioned
For decades, pharmacists have been seeking support, acknowledgement, and funding for the provision of cognitive services. By and large, we’ve not seen widespread support for transforming payment for pharmacist-provided services over this stretch of time. However, there are 2 general exceptions: (1) support for services as a function of academia, wherein the time or position is supported through teaching or research, and (2) support for services that produce a negative QALY.
What’s a QALY? A quality adjusted life year is a health-policy wonk’s way of expressing the cost of a procedure, medication, or intervention per year of quality gained by the average patient. QALYs are meant to provide us with the relative value of a health care expenditure intended to improve health. An example might be $202,000 per additional quality year of life gained for a left-ventricular assist device.5 Countries often use QALYs, such as in the United Kingdom’s National Health Service, to determine which services to provide and with what availability when considering limited resources. Relative cost-to-benefit or cost-to-effectiveness can also be charted on a cost-effectiveness plane (Figure), where the “Northwest” portion of the plane is low value and should not be considered for coverage because the intervention is more costly and less effective at achieving the outcome of interest. The “Northeast” and “Southwest” quadrants present a dilemma for insurers and policy makers because there is no clear distinction. Interventions in the “Southeast” quadrant are more effective and cost less than alternative treatments to achieve the same ends.
Pharmacists have been held to a “negative” QALY standard. That is, our involvement in the health care system, beyond dispensing, has been generally subject to improving outcomes while saving money. Relegated to the “Southeast” corner of the cost-effectiveness plane, we’ve had to demonstrate (sometimes extreme) relative value in order to fund clinical pharmacist full-time equivalencies.
Value-Based Reimbursement Ushers in Scalable Opportunity
As we move ever so steadily toward a system of financing built on value proposition and population (panel) management, interventions and activities with a preventative foci that save money through increased health and improved health outcomes will be sought with great vigor. What was once a cottage industry of pharmacists scraping by through repeated attempts to justify their value in a fee-for-service world can become a scalable endeavor in an outcomes marketplace. Just ask 3 DC-based consulting organizations: The Advisory Board Company, the National Governors Association, and Leavitt Partners.
Troy Trygstad, PharmD, PhD, MBA, is vice president of Pharmacy Programs for Community Care of North Carolina (CCNC), which works collaboratively with more than 1800 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors for the American Pharmacists Association Foundation.