Virtual pharmacist care expands access and controls costs for Medicare populations

Easy access to attentive pharmacists increases health outcomes. There used to be an independent pharmacy in every town. Even the early pharmacy chains gave instant access to a pharmacist whenever you needed them. A pharmacist was a quick walk, drive, or call away.

As some large pharmacy benefit managers and insurance companies started owning pharmacies priorities shifted. Regular and easy access to a pharmacist was traded in favor of truncated hours, decreased access, and centralized pharmacies that make picking up a phone and speaking to a pharmacist feel impossible.

Increasing access to pharmacists through easy access virtual programs aimed at increasing health outcomes is a viable solution to change the story about failing health outcomes.

Through high quality remote access to pharmacists that manage medications and particular disease states, what was once a pharmacist you could call anytime becomes a mechanism for health transformation without needing to drive or travel long distances, or have long wait times until an appointment becomes available.

Pharmacy school training has expanded, and agencies like the Veterans Administration (VA) have begun to name pharmacists as chronic disease management experts. Pharmacists began showing unparalleled impact in disease markers like blood pressure management, HbA1c control, and outcomes we associate with “care gap closure.”

The VA has long understood the value that a pharmacist brings to the payer who also provides the care, which is the government model the VA follows, as they keep costs in-house. Insurance companies have been slower to catch on to the impact that pharmacist-led disease management programs can play in managing costs and increasing revenue through excellence in health outcomes. The pharmacy benefit managers are beginning to recognize pharmacist impact on chronic health outcomes and are more frequently offering buy-up programs that utilize pharmacists to increase health outcomes as health costs continue to balloon, and reimbursement for government programs like Medicaid decreases.

Insurance companies with government contracts are held to standards. They have historically been able to have mediocre programs and still receive payout from CMS. Payers can blame poor outcomes on population resources, lack of access, and ask for handicaps to subsidize the current inability to manage chronic disease, especially in high-risk populations. However, the pairing back of incentives afforded by government programs in recent years now makes it impossible to survive as a payer unless you find a way to keep the populations you serve healthy, and out of the hospital.

Pharmacists are the best option to provide this kind of solution, and they don’t need AI to scale. It is second nature for a pharmacist to excel at what they do. It is natural for them to take care of large and complex populations. Pharmacists are well-versed as business leaders, stemming from years of tradition in independent pharmacy. It’s easy for the pharmacist to see the value in the bottom line.

Pharmacists might be better than anyone else at providing chronic disease management. Better than the nurse practitioner or PCP who is already overwhelmed trying to take care of patients and meet quality metrics imposed by insurance companies so they can get paid. The PCP also becomes responsible for the quality outcomes of specialists. How can health move forward with a model like this? What kind of infrastructure is required to answer the needs of a sick and aging population?

               For years pharmacists have specialized in areas called “Ambulatory Care Pharmacy,” or “Embedded Pharmacy,” both code words for pharmacists who manage disease. In lieu of having a pharmacist in every office, or large provider practice (which we are also moving towards), virtual chronic disease management by pharmacists allows scalability and access. We need solutions for high-risk populations with access issues to their PCP office due to cost, disability, resources, or distance barriers. Programs that allow payers and government programs to not only manage cost, but provide excellent care and unparalleled health outcomes. Virtual pharmacist-led disease management is the answer.