In March 2010, President Obama signed into law the Affordable Care Act (ACA) of 2010 with provisions to reform healthcare over a period of years. The provisions are much needed changes to our current health care structure and strive to improve the access to and the quality of patient care. Within the ACA, there are exciting opportunities for pharmacy that include expanding Medication Therapy Management (MTM) services, evaluating delivery models to include MTM delivery, and investigating new ways to reimburse for health care services.
Additionally, there are various “hidden opportunities” for pharmacists to assist with other provisions to improve the quality of care. Readmission rates will be monitored and tied to reimbursement for hospitals especially for high risk persons and persons with certain high risk conditions, such as heart failure, post-myocardial infarction, and pneumonia. What a great opportunity for pharmacy to help with this provision! This could be done through medication reconciliation, phone or home follow-up visits soon after admission, designing post-hospitalization clinics, and on and on; the possibilities are endless! Health care providers will also need to document that there is “value” to the care they provide. Some of this is through the use of continuous quality indicators (CQI) that are tied to reimbursement, creating a “pay for performance” model. It is well known that mid-level providers, such as pharmacists, will be needed to assist and providers will be limited in number to provide the follow-up required to meet the benchmarks. Pharmacists have a great opportunity to help providers and practices meet CQIs through disease state management clinics, providing patient education and monitoring, assuring adherence and follow-up, and so forth.
Within ACA, provisions to evaluate the Patient-centered Medical Home (PCMH) exist. This is a physician-led team of health care professionals with the goal of providing the best care for the patient and engaging the patient in his/her care. Pharmacists can play a key role within the PCMH through a variety of ways, such as providing MTM, preventative services, and disease state management programs.
With all these opportunities, pharmacists need to be proactive to ensure we are part of new delivery models and our knowledge and set of skills are put to use. Unfortunately, pharmacists could be easily overlooked as health care systems, clinics, and insurers are designing new delivery models due to the lack of wide-spread involvement of pharmacy in direct patient care. This is the time for pharmacists to embrace these changes. Given the amount of education and training that pharmacists undergo, we are “under-utilized” health care professionals. We need to step up and advocate for a role in the various areas of health care reform. Pharmacists need to be ensuring that each patient has the most clinically effective, safe, and cost-effective therapeutic regimen by incorporating each patient’s individual factors and evidence-based medication. It is time that pharmacists ensure that each medication a patient takes is appropriate and effective for the person and his/her diseases and safe without harmful drug-drug ...