3 Ways Pharmacists Can Improve Benefit Plans

Pharmacists are consistently among the most trusted professionals. How can we better leverage them to improve patient care?

According to a 2018 Gallup poll, pharmacists are consistently among the most trusted professionals, just behind nurses and doctors.[1] Patients and doctors respect their educated advice, which is why pharmacists are moving toward the center of the healthcare team.

Most pharmacy benefit managers (PBMs) employ pharmacists but do not use them to their fullest potential. EmpiRx Health, a value-based healthcare company that provides a full suite of PBM services, embraces a practical population health management strategy where pharmacists work in a multimodal fashion to improve patient outcomes and reduce healthcare costs.

These pharmacists have evidence-based clinical conversations with doctors about switching to more cost-effective therapies that have the same or better clinical outcomes. Our clinical peer-to-peer conversations are extremely impactful, as demonstrated in the following case study. This approach has resulted in an average 2.3% drug trend across our book of business.

EmpiRx Health pharmacists stratify membership by risk, not medical condition, to identify patients who may benefit—both clinically and financially—from a change in therapy. They successfully engage with doctors 88% of the time and are able to negotiate therapy switches 64% of the time. Our clinical pharmacists consistently achieve optimum results by applying three proven strategies.

1. Use a Population Health Management Approach to Streamline Patient Needs

Medication interventions by pharmacists are most effective when they collaborate closely with doctors and nurses.[2] EmpiRx Health pharmacists build productive clinical relationships by conducting direct contact with doctors as part of our population health management strategy.

This approach involves stratifying at-risk patient populations in a condition-neutral manner using an EmpiRx Health engine powered by the Johns Hopkins ACG model. It guides our pharmacists to identify those patients that require additional attention or that would benefit from enhanced interventions. These interventions result in better patient outcomes and lower net costs for plan sponsors and their members. 

2. Provide a Tailored Concierge Experience for Patients

In a hospital setting, patients expect to have their doctor, nurse, and pharmacist at their bedside. EmpiRx Health believes the experience of its members should not be markedly different outside of the hospital just because the pharmacist is remote. Our pharmacists reinforce their role on the care team by working directly with the patient’s doctor on clinical consultations to adjust medication therapies. We reach out to patients to update them on the status of prescription reviews, answer any questions they may have about their specialty drugs, and can even provide information on financial assistance.

When patients are discharged from the hospital, pharmacist counseling and follow-up calls can reduce readmission rates, improve medication adherence, and increase the chances that patients will attend their doctors’ appointments.[3] EmpiRx Health takes this one step further. Throughout the course of therapy, we call patients to discuss adherence, identify possible reactions or adverse effects, and reinforce education. Clinical calls to patients engage them in their healthcare decisions and ensure they are comfortable with their prescribed medications.

3. Employ Effective Behavior Change Strategies to Overcome Advertising Influence

Aggressive advertising campaigns for newer medications (which are not always clinically superior) can sway doctors into prescribing these more expensive medications, particularly if their patients have been allured by the same ads. By identifying individual doctors that prescribe mostly non-preferred drugs and educating them about appropriate and proven alternatives, EmpiRx Health pharmacists prevent excessive cost without sacrificing care. The goals of these interventions are to develop working relationships with doctors to promote impartial prescribing practices.

The benefit patients see from increased pharmacist contribution is clear, and EmpiRx Health is applying the same proven methods used in clinical practice sites to the managed care arena. Removing barriers in communication between healthcare professionals improves coordination, team performance, and patient outcomes.[4] The comprehensive multimodal communication system that EmpiRx Health has created enhances the exchange of information among all parties. By developing and applying these measures, patients are better served, coordination among their care team is improved, and a differentiated financial outcome is reached.

[1] Brenan M. Nurses Again Outpace Other Professions for Honesty, Ethics. Gallup. https://news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty-ethics.aspx. Updated December 20, 2018. Accessed July 8, 2019.
[2] Cebron Lipovec, N., Zerovnik, S. & Kos, M. Pharmacy-supported Interventions at Transitions of Care: and Umbrella Review. Int J Clin Pharm (2019). https://doi.org/10.1007/s11096-019-00833-3.
[3] Sanchez, G. M., Douglass, M. A. and Mancuso, M. A. (2015), Revisiting Project Re‐Engineered Discharge (RED): The Impact of a Pharmacist Telephone Intervention on Hospital Readmission Rates. Pharmacotherapy, 35: 805-812. doi:10.1002/phar.1630.
[4] Kogan, et al. (2010). Performance Improvement in Managed Long-Term Care: Doctor Communication in managing community-dwelling older adults. Home Healthcare Nurse, 28(2):105-114.


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