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Why Comprehensive Medication Management Should Become the Standard of Care

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The U.S. health system’s current standard of care for optimizing medication therapy is not working.

Although physicians and other providers undoubtedly prescribe with the patient’s best interest in mind, time constraints in the clinic and hospital settings make it challenging to consistently perform medication reconciliation, education, and regimen review at every visit.

This all too commonly leads to what the American College of Clinical Pharmacy (ACCP) refers to as inadequate therapy - which includes dose too low, different or additional drug needed, or wrong drug. 57% of medication therapy problems are the result of inadequate therapy. Including the reasons dose too high (6.83%) and unnecessary therapy (6.68%) brings the number to just over 70%.[1] The primary reason these problems occur is that, after clinicians prescribe a medication, time paucity during subsequent visits or hospital episodes makes it difficult to review and optimize therapy on a continuous basis.

Add to this data that staggering increase in polypharmacy patients - those who regularly take at least five prescription drugs. The number of these patients nearly doubled between 2000 and 2012, from 8% to 15%. And the more medications a patient takes, the more opportunity for side effects, drug interactions, and other adverse drug events. 

These are all aspects of what’s referred to as non-optimized medication therapy. And it costs a lot in dollars and lives. Recent data indicate that the annual cost of nonoptimized medication therapy is $528.4B in 2016 US dollars and 275,689 deaths per year.[2]

That’s why our health system’s standard of care for managing and optimizing medication therapy must change. And it is, albeit not fast enough, through the proliferation of comprehensive medication management services.

Led by clinical pharmacists, comprehensive medication management is a whole-person approach to medication therapy. It considers not only the patient’s medications, but his or her condition, clinical history, interventions tried and failed, past and present lab and test results, problem list, and clinical notes.

Supported by collaborative practice agreements that empower pharmacists to modify dosages and add or discontinue medications without physician approval, the pharmacists who deliver comprehensive medication management services function as highly trained members of the care team. These pharmacists conduct face to face or telehealth visits with patients, modify medication regimens, and document all activity and notes in the patient’s electronic health record (EHR).

It’s this level of service and care that we must move to if we want to truly optimize therapy for patients. Here are five reasons why it’s time for comprehensive medication management to become the standard of care for every provider, payor, and patient. 


1. Pharmacists are the best choice for medication management

Physicians and mid-level providers have been the primary purveyors of medication knowledge in the modern age of medicine. But they do not receive the depth of pharmacology education and training as pharmacists do. Physicians are trained to diagnose, treat, and care for medical needs. Pharmacists are trained in the knowledge and science of selecting and managing medications. As such, pharmacists - especially those who’ve completed clinical pharmacy residencies - are best equipped to manage medication therapies for patients. 

2. Better outcomes and lower costs

Comprehensive medication management by its very nature is focused on improving the health and outcomes of high risk, complex, polypharmacy patients. Get the Medications Right, a report summarizing the responses of 935 pharmacists and pharmacy professionals, found a variety of positive outcomes and cost reduction results achieved by programs and organizations across the country.

For instance, the study identified demonstrated reductions in emergency department and hospital admissions and improvements in metrics related to chronic conditions such as asthma, diabetes and hypertension, and other illnesses, including schizophrenia. And cost savings reported by survey participants showed financial return on investments that ranged from 2.8-to-1 to 12-to-1.[3] 

3. Essential under risk and value-based reimbursement agreements

Risk arrangements require that all resources be used effectively. When pharmacists manage the medication therapy, education, adherence, and ongoing regimen monitoring, costs go down. (See reason 2, above.) If comprehensive medication management improves patient outcomes and lowers costs, provider organizations reap more of the financial benefit of their risk based agreements. 

4. Technology can finally support and scale it

In the last three to five years, remote monitoring and telehealth platforms have become robust and yet cost effective enough to make comprehensive medication management services possible on a wider basis. They enable clinical pharmacists and their teams to visit with and manage patients even when exam or consultation rooms are not available, or patients aren’t able to attend additional visits. They also extend the care team of a clinic or hospital using platforms that enable remote pharmacy staff to improve medication oversight. 

As an example, New York-Presbyterian/Weill Cornell Medical Center is using telehealth technology at the bedside in its emergency department to facilitate medication reconciliation. The chaotic pace of an ED often results in these reconciliations not being done. But using telehealth, pharmacy technicians and interns can review medications with patients. Their access to pharmacy and EHR data improves accuracy and completeness.

At Cureatr, we’re leveraging telepharmacy services to deliver Medication Management Support services too. We supply provider organizations and health systems with board-certified clinical pharmacists to assess patients, evaluate medication therapies, develop medication care plans, and handle follow-up and monitoring.

These pharmacists use Cureatr’s Meds360 medication platform and become an extension of the care team to deliver comprehensive medication management that optimizes patient outcomes. Care is coordinated across providers and settings so patients are always getting the most from their medication regimens.

5. It may be a way to reduce physician workloads

Data indicate that when pharmacists deliver comprehensive medication management services through collaborative practice agreements, it maximizes the efficiency and effectiveness of other primary care providers on the care team. A practice within the William S. Middleton Memorial Veterans Hospital that measured this improvement found that adding one clinical pharmacists for every three primary care providers produced a 27% reduction in primary care workload. Such workload reductions can potentially ease the strain of physician burnout.[4]

[1] Comprehensive Medication Management in Team-Based Care, American College of Clinical Pharmacy, https://www.accp.com/docs/positions/misc/CMM%20Brief.pdf. Last accessed, 5/27/19.

[2] Watanabe JH1, McInnis T2, Hirsch JD1, Cost of Prescription Drug-Related Morbidity and Mortality, Annals of Pharmacotherapy, September 2018. Epub 2018 Mar 26. https://www.ncbi.nlm.nih.gov/pubmed/29577766. Last accessed, 5/27/19.

[3] McInnis, T. Capps, K. Get the medications right: a nationwide snapshot of expert practices—Comprehensive medication management in ambulatory/community pharmacy. Health2 Resources, May 2016

[4] McInnis, T. Capps, K. Get the medications right: a nationwide snapshot of expert practices—Comprehensive medication management in ambulatory/community pharmacy. Health2 Resources, May 2016

Whitepaper: Medication Management Challenges and Opportunities for Payers and Providers


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