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How Carilion Clinic saved $1.7M by expanding the role of pharmacists

September 15, 2017

    Historically, there has been minimal to no coordination between the hospital, physician office, and community pharmacy settings around medication management. This failure to coordinate may lead to fragmented patient care, discrepancies in medication documentation, medication misuse, adverse drug events (ADEs), and unnecessary hospitalizations and emergency department visits.

    Pharmacists are well-positioned to smooth these transitions by optimizing medication regimens and supporting patients' self-management of chronic conditions.

    In 2012, Carilion Clinic received a three-year, $4.2 million CMMI Innovation Grant to test the impact of expanding the role of pharmacists in both the clinic and community pharmacy setting. Here's how it worked.

    IHARP model optimizes medication management for rural, high-risk patients

    As part of its model, known as IHARP (Improving Health for At-Risk Rural Patients), Carilion Clinic embedded seven primary care clinical pharmacists (PCCPs) in 22 practices to provide ongoing medication management and support to high-risk patients. These ambulatory pharmacists were also supported by hospital pharmacists at seven hospitals and community pharmacists at 30 independent and chain pharmacies throughout the region.

    In this model, hospital pharmacists identified high-risk patients, who had to meet the following requirements:

    • 1+ hospital admissions within last 28 days or 2+ admissions or ED visits within the last year
    • 2+ chronic conditions
    • 4+ long-term medications
    • In-network, participating primary care provider
    • 18 or older, English-speaking, with access to telephone

    Patients did not qualify if they had a terminal condition with a life expectancy of six months or less or if they were being discharged to a nursing home.

    How IHARP pharmacists work across the continuum

    After identifying patients as good candidates for ambulatory pharmacist support, hospital pharmacists introduced them to the program and PCCP concept by providing a brochure. Hospital pharmacists also faxed the hospital discharge summary to the PCCP, who then contacted patients within 72 hours of discharge to assess their transition home and schedule a face-to-face appointment.

    Once an initial relationship was established, the PCCPs would then integrate the medication care plan into the existing care plan, provide education, monitoring, and medication management, and continue to contact the patient every three months to assess status and resolve medication-related problems.

    Community pharmacists also played a critical role in the model, notifying PCCPs of all new drugs prescribed as well as checking blood pressure, weight, and other clinical status markers when patients filled prescriptions. These individuals had read-only access to the complete EHR and could make use of a secure messaging platform to report new information back to the PCCPs.

    Preliminary results indicate the model lowered total costs of care by $1.7 million due to 5,500 pharmacy interventions that reduced drug use and ED and hospital visits. Additionally, the model demonstrated improved chronic disease markers and improved patient and provider satisfaction, adding to the growing body of evidence that deploying pharmacists in ambulatory care settings is a great lever for improving population health. This particular example also shows that the benefits of embedding a pharmacist in the clinic setting extend to high-risk patients in rural areas.

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