Value-Added Services in a Patient-Centered Medical Home

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Value –added services can occur in a broad array of settings and under multiple types of arrangements. There is much opportunity for pharmacists to demonstrate their value in patient-centered medical homes (PCMH). PCMH are a care delivery model whereby patient treatment is coordinated by their primary care physician that may include a centralized setting that facilitates partnership with patients, patients’ families, and other health professionals. Care is is typically delivered beyond one facility, though, through these partnerships, often under the premise of collaborative working relationships (CWRs). In PCMH, providers agree to contract with sponsors/plans to provide a comprehensive set of care services for patients perhaps under capitation or some other type of structure involving risk. PCMH have been envisioned for quite some time to become the principal mechanism of care delivery and coordination. While there are several hundred PCMH nationally, they are not yet as prevalent as initially envisioned, but still hold much promise to be the future of health care.

Farris et al piloted a model that extends pharmacists’ direct care from a medical home to community pharmacies.1  Legal agreements were developed for sharing data and accessing patients’ medical records in CVS pharmacies. An immersion model was used to train two community pharmacists to provide direct patient care and change medications to improve disease control. These pharmacists provided comprehensive medication reviews in either the PCMH clinic or in CVS pharmacies. The study evaluated patient A1C and blood pressure readings for patients seen by community pharmacists. Of 503 shared patients, 113 received a comprehensive medication review (CMR) from a community pharmacist. For the community pharmacist group, the odds of patients with an A1c  at or below 9% increased by 8% in each time period, while the odds decreased by 16% for the control group. No significant differences were seen in the outcomes for patients seen by PCMH vs community pharmacists. Most patients rated the care they received as excellent.

Given adequate resources, pharmacists can potentially provide the same types of services found in specialty types of environments and can demonstrate their value in integrated delivery models such as in a PCMH, whether in-house or contracted. This study would need to evaluate implementation factors to determine its sustainability but nonetheless shows promise for the intervention. Pharmacy managers should always be on the lookout for potential CWRs that demonstrate the value of pharmacist services and diversify revenue streams and reimbursement strategies for the pharmacy.

Additional information about Value-Added Services as a Component of Enhancing Pharmacists’ Roles in Public Health can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing. 

1Farris KB, Manzor Mitrzyk B, Batra P, et al. Linking the patient-centered medical home to community pharmacy via an innovative pharmacist care model. J Am Pharm Assoc. 2019;59(1):70-78. 

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California


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almost 2 years ago

How prevalent are medical homes in your area? Are you receiving better care? What’s the prognosis for pharmacists?