Clinical pharmacists: A critical link for managing chronic conditions effectively

September 21, 2019

CMS’ emphasis on preventive care and the need for better chronic care management raises the need for a care coordinator to ensure medication management and monitor for potential contraindications. The ideal coordinator? Clinical pharmacists.

Over the years, the U.S. healthcare system has struggled to combat rising costs with no real improvement on patient outcomes. Some of the initiatives to address this have been genuine, while others seem to be more form than substance. Now, the Centers for Medicare & Medicaid Services (CMS) seems to be driving a concerted effort to move the focus from treatment to the prevention and proactive management of chronic diseases.

Physicians should think seriously about how to get on board with these initiatives. Otherwise, they run the risk of having to manage an increasing number of patients suffering from chronic diseases, thus further burdening their care teams and the healthcare system even more.

Chronic diseases, such as type 2 diabetes and other cardiometabolic conditions, are drivers of skyrocketing healthcare costs. They’re also potential catalysts to change the way we think about delivering healthcare. The Centers for Disease Control and Prevention (CDC) estimates that six in 10 adults have a chronic condition while four in 10 suffer from two or more. These chronic diseases are the leading cause of death and disability and account for 71 percent of total healthcare spending in the nation.

According to a recent survey, 85 percent of providers feel they don’t have enough time to address all of their patients’ clinical concerns, which leaves patients to fend for themselves when it comes to care management and health needs. Providing incentives to encourage physicians to focus on prevention and outcomes up front is part of the solution. In doing so, they can better identify which patients may have reoccurring issues earlier, leading to preventive measures being taken to inhibit the progression of a chronic disease. The result? Decreased staff burden.

In addition, we must think about new workflows to encourage meaningful contributions by every member of the care team in better and more efficient ways. This clearly includes primary care physicians (PCPs) and specialists, such as endocrinologists and cardiologists, but it also must include non-physician providers and clinical pharmacists, those who provide direct patient care that optimizes the use of medication and promotes health, wellness and disease prevention.

Supporting primary care

The continual needs of the chronic care population are taxing our healthcare system at a time when we are also facing a shortage of PCPs. This shortage underscores the need for hospitals and practices to look beyond a single doctor as a panacea, and instead rely on a team-based care approach in which all members practice at the top of their license and share the collective responsibility for addressing patients’ needs.

Clinical pharmacists, for example, are crucial in a team-based care approach, especially in supporting the PCP. As frontline engagers with patients, clinical pharmacists have a 30,000-foot view into the types and dosage of medications patients are taking to manage their diseases, especially since multiple prescribers are usually involved. With knowledge and training that focuses on treating multiple conditions with therapeutic contraindications, clinical pharmacists are able to play an integral role in improving the health of patients, shouldering some of the PCPs’ burden of patient management and medication adherence.

Seeing the bigger picture

PCPs and disease specialists face a significant challenge in optimizing care for patients with a range of comorbid diseases and complex set of potential contraindications. Siloed into their specific specialties, these physicians are focused on providing the best care within their “zone.” By having the ability to see all of a patient’s medications and diagnoses - both past and current - pharmacists are uniquely trained to help. This includes examining a patient’s whole health history and understanding how lifestyle, medical treatment and personal choices are, or could be, impacting his overall well-being.

For example, clinical pharmacists often are able to develop stronger personal relationships with patients, which serves as an important step in education and patient engagement. Clinical pharmacists are there to answer patients’ questions about medications and take an active role in educating patients about their diseases, enabling them to fully understand how their lifestyle choices and treatments may impact their health.

In fact, one study found significant evidence to support the role of pharmacists in providing a range of extended diabetes care services, from routine screenings to ongoing disease management. The study further notes that pharmacists could be the first line of defense in diabetes screening, particularly for those who are living with the disease undiagnosed.

Clinical pharmacists also play an important role in ensuring patients take their medicine properly and on time. For individuals with chronic conditions, the result of not adhering to medicine regimens can be severe and can result in complications such as heart disease, stroke and organ failure. The American Heart Association reports that 125,000 Americans die each year from poor medication adherence, while the lack of medication compliance costs the healthcare system nearly $300 billion a year in additional doctor visits, emergency department visits and hospitalizations.

Using technology to connect and scale care teams

PCPs, clinical pharmacists and specialists all have important roles to play in supporting patients with chronic diseases. However, it is essential that care teams use technology platforms that bridge electronic health record (EHR) data with patient-generated health data (PGHD) to provide a more complete and intuitive view of patients. Thus, clinical pharmacists can coordinate with physicians, and vice versa. The ability to use analytics tied to the clinical workflow that allow the real-time exposure of gaps in care and access clinical recommendations based on the latest guidelines are just two important enablers of implementing these approaches and scaling them across large populations.

And while it’s true that technology implementation can be daunting, it’s important to focus on technologies that not only address these issues in a scalable way, but that use a standard interface such as FHIR to integrate with the EHR.

 The healthcare community is right to incentivize the prevention and proactive management of chronic diseases. As a solution, the model of team-based care provides its own advantages of collaboration, cost efficiency and a better quality of care for patients. As critical members of the care team, clinical pharmacists are on the frontlines of patient management and are rightly suited to lend a hand in chronic care management. However, it’s up to health systems and physician practices to acknowledge these benefits and adapt this model of care to ultimately deliver quality patient care.

Joshua Claman, MBA, is CEO ofRimidi, a cloud-based software platform that enables personalized management of chronic cardiometabolic conditions across populations. He has more than 25 years of technology experience and has worked in executive positions for Dell, ReachLocal and Stratasys.