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Amid access and cost challenges, U.S. health system turns to pharmacy

BY Jim Frederick

It’s time.

With the nation struggling to pay its massive health bill, medical schools turning out fewer and fewer primary care doctors, 10,000 boomers a day turning 65 years old and putting new stress on Medicare and health services, the Affordable Care Act demanding new cost-saving solutions to front-line care, and chronic diseases reaching epidemic proportions, it’s clearly time to fully engage the nation’s nearly 180,000 community pharmacists in the urgent campaign for a more effective, more accessible and less costly healthcare system.

The pharmacy profession — and the industry it drives — is up to the challenge. Armed with a doctorate in pharmacy and advanced training in pharmacology, population health, clinical care and patient counseling, today’s community pharmacists are ready and able to do more to help relieve the stress on the nation’s vast, overburdened and staggeringly expensive healthcare system.

Indeed, they’ve already stepped up as frontline providers of vital services like immunizations, medication therapy management, disease prevention, health screenings and healthy lifestyle counseling. And with a fairer and more rational payment system for pharmacy services in place, they could do much more to improve Americans’ overall wellness and curb the rising health cost spiral.

“Retail community pharmacists provide high quality, cost-efficient care and services, especially for patients with chronic conditions,” noted Steve Anderson, president and CEO of the National Association of Chain Drug Stores. “However, the lack of pharmacist recognition as a provider by third-party payers, including Medicare and Medicaid, has limited the number and types of services pharmacists can provide, even though fully qualified to do so.”

“Pharmacists play an increasingly important role in the delivery of services, including key roles in new models of care beyond the traditional fee-for-service structure,” Anderson added. “Pharmacists are engaging with other professionals and participating in models of care based on quality of services and outcomes, such as ACOs (accountable care organizations). They’re also partnering with healthcare providers working in nearby health systems and hospitals, serving as part of care teams to help improve patient health and outcomes.”

NACDS calls pharmacists “the face of neighborhood healthcare — the final link in a chain of care that extends from health providers to patients, and unquestionably the nation’s most accessible health professional.”

‘We need to make changes’ 

The growing reliance on pharmacists as fully engaged and clinically capable members of the modern patient-care team couldn’t come at a better time. Costs of acute care services and hospitalizations have skyrocketed. And the nation’s growing shortage of primary care physicians — traditionally the first line of care for most Americans — is reaching critical levels.

This growing squeeze on the number of primary care physicians has made access to affordable healthcare a hot-button issue. And it comes even as the U.S. health system is in the midst of a “back to basics” movement that’s “making primary care once again the critical touchpoint,” according to PriceWaterhouseCoopers’ Health Research Institute. “Besides elevating the role of primary care physicians, that movement is also elevating the critical importance of pharmacists, retail clinicians and other health professionals who extend and supplement the role played by family-practice doctors in a team-based, more collaborative network of frontline care,” PwC reported recently.

“America’s population is living longer than ever before; however, the number of people suffering from chronic disease is at an all-time high and growing,” noted Dr. Harry Leider, chief medical officer at Walgreens, in a report for the Congressional newspaper The Hill. “Almost half of U.S. adults — approximately 117 million people — have at least one chronic disease, resulting in three-quarters of our nation’s annual healthcare expenditures going toward costs for treatment and management of these conditions.

“We’re also challenged with a primary care physician shortage that’s only supposed to worsen, with the Association of American Medical Colleges predicting that in five years there will be nearly 100,000 fewer doctors than the number needed,” Leider added. “And, of course, there is the influx of newly insured individuals into the healthcare system as a result of the Patient Protection and Affordable Care Act.”

“Against this backdrop, it’s clear we need to make changes to our system to counter these trends that will only continue to hinder patient access,” he noted. “One viable solution is to promote the important role that community pharmacists can play in providing patient care, in the same manner as other non-physician providers like nurse practitioners and physician assistants.”

Many of the stakeholders who will determine the future direction of health care in America are beginning to heed that advice. Government and privately run health plan payers, hospital-based health systems and time-pressed family physicians are turning to pharmacies nationwide to provide more cost-effective and accessible frontline healthcare services.

“It’s often said that pharmacists are the most underutilized healthcare professional in the healthcare system,” said Anne Burns, VP of professional affairs at the American Pharmacists Association. “That’s changing as policy-makers, media outlets, healthcare administrators, and physicians and other members of the healthcare team highlight the value that pharmacists can bring to improving patients’ health and medication outcomes.”

To see the full report, click here.

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Pharmacy’s grassroots presence is telling

BY Randy Edeker

Randy Edeker, chairman, CEO and president of Hy-Vee and NACDS chairman of the board

Pharmacy’s engagement with legislators through the National Association of Chain Drug Stores RxImpact grassroots program provides a window into the industry and the profession.

Face-to-face interactions between patients and pharmacists contribute substantially to pharmacy’s value and position of trust. In a survey commissioned by NACDS last summer, half of respondents indicated that they had spoken with a pharmacist in the past 12 months about a question related to a prescription drug. They spoke with a pharmacist about an over-the-counter medication at the same rate. Three-in-10 spoke to a pharmacist about a personal health question.

Given that personal contact between patients and pharmacist is a hallmark of community pharmacies, it is only fitting that relationships between pharmacists and legislators help to develop policies that can improve access to health care.

Members of Congress have become familiar with NACDS RxImpact Day on Capitol Hill, now in its eighth year. In 2015, NACDS members conducted 462 meetings during this “Hill day,” reaching more than 85% of the U.S. Congress. Yet, the grassroots engagement of NACDS members goes beyond these meetings in Washington, D.C.

NACDS members last year hosted 156 pharmacy tours and other events for members of Congress in their states and districts. In addition, the NACDS RxImpact program invested in the future of pharmacy’s grassroots engagement by conducting 24 grassroots training programs for member companies and for colleges and schools of pharmacy.

In 2016, NACDS RxImpact Votes — the bipartisan get-out-the-vote arm of the grassroots program — is focusing on educating pharmacy personnel about opportunities to make their mark on the elections by volunteering for, and building turnout for, the candidates of their choice.

NACDS members have a somewhat unique grassroots strength in that — collectively — they operate stores in every congressional district and state. Pharmacy’s commitment to leverage this presence and to engage in productive dialogue with legislators reflects pharmacy’s role as the face of neighborhood health care. We look forward to working with members of Congress on an ongoing basis for the benefit of patients and consumers.

To see the full report, click here.

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A look back reveals pharmacy’s strides forward

BY Steve Anderson

Steve Anderson, IOM, CAE, NACDS President and CEO

It is amazing how a 2008 initiative has marked pharmacy’s progress in helping to improve access to high-quality, cost-effective patient care.

Eight years ago, the National Association of Chain Drug Stores and allied organizations released a document entitled “Project Destiny,” which sought to facilitate pharmacy’s healthcare services beyond medications. The document stated: “Pharmacists … are well suited for providing patient care that ensures optimal medication outcomes and can contribute to the lowering of overall healthcare costs. … ‘Project Destiny’ has identified potential mechanisms for offering services to patients that are valued by the healthcare system which can be replicable, scalable and economically viable for community pharmacy.”

Since that time, NACDS members have made tremendous strides in innovating healthcare delivery. Along the way, we have seen examples of how federal and state policies can help foster these improvements, or threaten them.

Vaccinations present one example among many of how to leverage pharmacy’s value. At the federal level, health authorities have lauded pharmacies as critical vaccination access points during flu outbreaks. The military’s TRICARE program hails the success of its pharmacy-based vaccination program. At the state level, it is notable that in 2009 pharmacists gained the ability to administer the flu vaccine in all 50 states — when Maine took that step. Just last year, Georgia became the 50th state in which pharmacists can provide at least three vaccines.

Still, examples abound of the need to work continuously at the federal and state levels to preserve patients’ choice of pharmacies in Medicare, Medicaid and TRICARE to meet their medication needs. NACDS members look forward to talking with U.S. Senators and Representatives about these challenges.

In many ways, this special edition of Drug Store News — which is being circulated during NACDS RxImpact Day on Capitol Hill — provides a kind of update on “Project Destiny” and the story of pharmacy patient care’s evolution. It is up to all of us to ensure the positive story continues to unfold for the ultimate good of patients nationwide.

To see the full report, click here.

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