I have been thinking a lot lately about the future of pharmacy. This is such an exceptional time in healthcare with change all about us. There is a lot of focus on "value" in health care at this time; value-based programs are everywhere.
In the June 5, 2013 issue of JAMA, three of the most influential leaders in healthcare penned a two-page viewpoint "The Future of Quality Measurement for Improvement and Accountability," which communicated very concisely where quality programs should begin to aim. These leaders reinforce that quality measures need to reflect "assessments that are broad based, meaningful, and patient-centered in the continuum of time in which care is delivered" and that measures be "system-based outcomes measures with high public importance."
I am encouraged when I read reports about pharmacists playing key roles in services and programs that improve outcomes such as patient experience readmissions reduction or ensure chronic conditions are managed more effectively. However, I am aware that in some hospitals, pharmacy may not be involved in these efforts and perhaps are still struggling to be recognized for the value they may add. It seems we always have to prove ourselves in pharmacy.
Current efforts by the Patient Access to Pharmacists' Care Coalition (PAPCC) – that aim to achieve some degree of provider status – reflect this historical problem, but the positive early response to HR 4190 indicates that the environment is changing. With value-based programs now focused on outcomes linked to payment, the horizon of healthcare beyond fee-for-service is visible, and pharmacists appear to be well-positioned.
As the team-based model evolves, however, more challenges loom for pharmacy. The issue of attribution of value is already becoming a common discussion point. "How do we know what the value of the pharmacist was to our 25% readmissions reduction in our team-based service?" This is a legitimate question, but from my perspective it may be premature.
Considering the whirlwind of activity occurring at most health-systems, the initial question to focus on seems to be, "What worked?" Understanding what services actually improve patient satisfaction, reduce readmissions or decrease avoidable harm events is the game at hand for most of us. Pharmacy needs to be proactive and aggressive in this stage to ensure they are involved in the care design and delivery processes.
Once the "What worked?" issue is addressed with a specific program or service, the next logical question is, "How do we provide this service more efficiently?" While accountable-care models will certainly be held to quality of care standards, they will become keenly focused on efficiency of care delivery and cost containment. This is where I see some risks for pharmacy. Sometimes, in all that kicking and scratching to get on the team and be recognized, pharmacists pick up a variety of tasks for which we might not be the most suitable clinician.
It is also easy to get a bit territorial and want to hold on to aspects of care delivery that we believe we own. But being a part of the team in the new health care environment will also mean being good stewards of organizational, payer and patient resources. It may be that pharmacists can use their knowledge to design programs and train others (i.e., Pharm Techs, MAs) to provide the service.
I attended a population health conference recently that shared data around cost per patient within an ACO model. The metrics that were shared looked at achieving quality outcomes versus the cost of care. A key cost determinant was the composition of the team. Be assured that we will have to justify our value in these new models. However, we can provide true leadership by proactively identifying opportunities to lower cost and improve efficiency.
There is no shortage of work in transforming our healthcare system and I am confident that, as pharmacists, we will rise to the occasion and play a critical role in helping to achieve this goal. Make sure to step back and take a deep breath now and then to ensure your practice is heading in the right direction and that you are positioned to meet the new demands and opportunities that will certainly present themselves.