Transition of Care to the Pharmacy

Lynn Altmaier, BS, BSN, RN, MSc Senior Medical Writer

As of January 1, 2013, the Affordable Care Act (ACA) requires health systems, including pharmacists and physician groups, to form accountable care organizations (ACOs) that work together to provide coordinated care for eligible Medicare Part D recipients. Pharmacists will be responsible for consulting with patients and their healthcare providers and conducting comprehensive medication reviews to optimize appropriate medication use. They have the education and experience to reduce medication-related problems and improve health outcomes through medication therapy management (MTM), health promotion, and education. They are also in a position to ensure the success of ACOs by mediating the use of medications, reducing medication-related adverse events, preventing hospital readmissions, and helping patients manage chronic conditions.

The Centers for Medicare and Medicaid Services recently approved Walgreens as the first pharmacy chain to be part of an ACO. Walgreens is partnering with physicians and hospitals to form ACOs in Florida, New Jersey, and Texas to help improve health outcomes, access, and convenience while lowering health care costs. Walgreens announced April 4, 2013 that it will be expanding services at its 360 Take Care Clinic locations to include diagnostic and treatment services for chronic conditions such as diabetes, hypertension, and high cholesterol. CVS, the nation's largest retail clinic chain with 620 MinuteClinic locations, also has plans to expand its primary care services to include chronic disease management. MinuteClinics are partnering with several large health systems, including Cleveland Clinic, UCLA Medical Center, and Indiana University Health to collaborate on disease management and patient education.

In addition to retail clinics, self-service kiosks that check vital signs and give advice about health and disease risk are being integrated into the market. Rite Aid has partnered with OptumHealth to deliver more cost-effective, "personalized" healthcare at the touch of a button. A person visiting a Rite Aid NowClinic can walk into a private room near the pharmacy counter, register online, answer a few questions about their health problem, and access free education or talk with a nurse via video chat at no charge. If a person wants to speak to a physician, he or she can pay with a credit card for a 10-minute visit and add additional time if necessary. Vitals such as blood pressure may be taken on an automatic cuff and communicated directly to the physician who might write a prescription, if appropriate, or refer the person to a local provider. The NowClinic, which initially started as an online system accessed from home, has expanded its in-store "virtual visit" kiosks to 22 states.

According to a RAND Health study, use of retail clinics increased 10-fold between 2007 and 2009.(1) And the number is expected to climb even higher after January 2014, when an estimated 30 million people who are currently uninsured get healthcare coverage under the ACA. With care initiated at retail clinics being 30% to 40% less expensive than similar care provided at a physician's office, and 80% less than care provided in an emergency room, retail clinics and self-directed care may not only be a means of convenient care, but an answer to our healthcare crisis.(2) A recent study found that the use of retail clinics was associated with a lower total cost of care, primarily due to lower medical expenses at physicians' offices and hospital inpatient care, and fewer emergency department visits.(3)

The U.S. Food and Drug Administration (FDA) is taking "self-service" to a new level with a recent proposal that would allow patients to use technology to evaluate their own health needs and obtain prescription medications over the counter at the pharmacy without ever seeing a physician. The FDA argues that many patients do not seek medical care or prescriptions for certain conditions because of the time and cost associated with seeing a physician and getting a prescription.(4) This new delivery model would allow some medications for chronic conditions, such as asthma and allergies, to be sold under "conditions for safe use." Criteria for conditions for safe use would be assessed using technology such as patient kiosks, remote diagnostic tools, and online questionnaires that determine a patients' needs and appropriate medications.

Janet Woodcock, MD, director of the FDA's Center for Drug Evaluation and Research, supports the proposal, stating "It is clear that there are now many interactive mechanisms that can step the consumer through the process of self-diagnosing and medication selection in a much more comprehensive manner than by them reading the drug fact box." Pharmacists would assist patients in determining their need for medications and help them verify their self-diagnosis. Diseases and conditions that require a confirmation of diagnosis or routine monitoring with diagnostic testing (eg, blood test for cholesterol levels or liver function tests) could be available in the pharmacy. Eric Juhl, director of federal public policy for the National Association of Chain Drug Stores, states "Pharmacists are not only qualified to help educate patients, they also are more accessible than any other health care professional due to the number of drugstores in the U.S. and their extended hours. They are experts in appropriate use of medications and are uniquely qualified to take on this new role."

Although the verdict is still out on how this transition of care to the pharmacy will impact the healthcare system, it is clear that there is an increased need for patient education at the point of care and tools to support continuity of care among providers. Pharmacists and retail clinics will need to be armed with educational resources to reinforce treatment plans, support adherence initiatives, and help consumers make decisions about their health care. Artcraft Health Education (AHE) has long been on the forefront of identifying the best solutions for patient education at multiple touch points. AHE understands the value of patient comprehension and retention in improving adherence and health outcomes. Whether it be a digital animation available at the touch of a kiosk button, take-home resources that simplify a medication regimen, or information about participating in a clinical trial, AHE can help.

References

1. Ashwood JS, Reid RO, Setodji CM, et al. Trends in retail clinic use among the commercially insured. Am J Manag Care. 2011;17(11):e443-e448. http://www.ajmc.com/articles/Trends-in-Retail-Clinic-Use-Among-the-Commercially-Insured. Accessed May 15, 2013.

2. Use of retail clinics rises 10-fold over two-year period. RAND Corporation. http://www.rand.org/news/press/2011/11/22.html. Published November 22, 2011. Accessed May 15, 2013.

3. Sussman A, Dunham L, Snower K, et al. Retail clinic utilization associated with lower total cost of care. Am J Manag Care. 2013;19(4):e148-e157. http://www.ajmc.com/articles/Retail-Clinic-Utilization-Associated-With-Lower-Total-Cost-of-Care. Accessed May 15, 2013.

4. Using innovative technologies and other conditions of safe use to expand which drug products can be considered nonprescription; public hearing. Department of Health and Human Services Food and Drug Administration. http://www.gpo.gov/fdsys/pkg/FR-2012-02-28/pdf/2012-4597.pdf. Published February 28, 2012. Accessed May 15, 2013.