When Robin Blakeney of Concord stopped taking some of her medications to save money, she ended up hospitalized for two weeks.
Blakeney, who has congestive heart failure, diabetes and high blood pressure, is the kind of fragile patient who accounts for an outsized share of America’s soaring health care tab. The federal government has invested $15 million in a North Carolina experiment that gives community pharmacists a new role in patient care.
The pharmacy project is part of a 10-year, $10 billion federal exploration to overhaul the nation’s health care system. The Affordable Care Act created the Center for Medicare and Medicaid Innovation to launch experiments in every state. Successes can serve as models for national reform.
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The office’s goal is lofty: making medicine less of an ordeal, improving patients’ health, and controlling the spiraling costs that burden taxpayers, employers and consumers.
The project created by the nonprofit Community Care of North Carolina gives pharmacists access to medical information about high-need patients and reimburses them for the extra work.
When Blakeney got out of the hospital this fall, Moose Pharmacy sent someone to her house to review her prescriptions and her follow-up care. Her drugs now come in a packet that she opens twice a day: eight pills each morning, four in the afternoon. The pharmacy delivers refills to her house, and pharmacist Carlie Traylor calls to check on Blakeney.
If the effort works, it will keep the 45-year-old woman healthier and out of the hospital.
“People generally know their pharmacists, especially the small-town ones. They’re a good community contact,” said Paul Mahoney, vice president for communications with Community Care, a public-private partnership dedicated to improving care and controlling costs.
Keeping patients on track
People with complex medical conditions generally have a long list of medications, often prescribed by different doctors.
A national study of Medicare patients with multiple chronic illnesses found that they see an average of 13 doctors and have 50 prescriptions filled per year, said Troy Trygstad, vice president for pharmacy programs at Community Care. They see a doctor two or three times a year – and a pharmacist two or three times a month, he said.
Even before the federal grant, Moose Pharmacy, which has five Cabarrus County locations, was part of a local medical network putting those contacts to use. Doctors make sure the pharmacist knows the patient’s treatment plan, and pharmacists make home visits to see whether that plan is being carried out.
Owner Joe Moose says his staff has made about 1,000 visits: “We have yet to have a patient who’s actually taking what the physician thought they were on.”
Some are confused about their regimen, while others are just forgetful. Some suffer side effects and drop drugs without consulting their doctors. Some, such as Blakeney, skimp when they run out of money.
As a result, controllable conditions can turn into crises, sending patients to the emergency room and leading to hospital admissions. Not only do costs skyrocket, but patients’ lives and well-being are put at risk.
“These are expensive failures,” Moose says.
Moose and his staff use tactics such as packing multiple medications together, making check-in calls and reminding patients of the need for tests, such as blood pressure checks and blood glucose monitoring for diabetics. If they see something going wrong, they can alert the doctor.
Blakeney says she loves the new approach. She said Moose Pharmacy lets her charge her medications and makes sure there are no gaps between refills.
Expanding the model
The Community Care program is working with about 120 pharmacies around the state, many in rural areas where distance adds to the challenge of seeing a doctor.
Community Care already works with 1,800 medical practices and asked those offices to identify pharmacies that would be good partners. Trygstad says he was pleasantly surprised by how readily the doctors embraced the idea of letting pharmacists help manage care for the most challenging patients – people with such conditions as heart disease, diabetes, behavioral health issues, asthma and chronic pain.
The traditional model involves very little contact between the doctors who write prescriptions and the pharmacies that fill them. The pharmacies are paid for the drugs they sell, regardless of whether they provide great personal service or none at all.
Under the new model, pharmacies get $70 to $95 for the initial work-up, which can take 30 to 90 minutes, and a monthly fee of $2 to $5 for each of the chronically ill patients taking part. There’s also a “pay-for-performance” reward based on such measures as patient health, quality of life, and reduction in hospital admissions and emergency room visits.
The grant program provides technology to ensure that pharmacies can track information about their patients, such as hospital admissions and discharges and care plans from all their doctors.
The Eshelman School of Pharmacy at UNC Chapel Hill is working with Community Care to monitor the program and tweak it to work better during the three-year grant. The federal government will also hire an outside evaluator.
The center is doing the same for grant recipients across the nation to determine whether successful results could be expanded. But those contractors are prohibited from disclosing data to anyone other than the center. The health law requires the federal government to disclose evaluation reports on its tests “in a timely fashion,” but so far the innovation center itself is largely silent.
One reason is that it’s early, officials say; there’s no reason to publish results in the first or second years of a three-year study. Another reason is the political risk of revealing the investments that don’t produce results. Some failures are inevitable, federal officials say, but even those will produce useful information on what doesn’t work.