If Not You, Then Who? Taking Advantage of the Opportunity for Change

In her address to Amnesty International, Harvard graduate and award-winning author Margaret Atwood once warned, “Powerlessness and silence go together.”¹ Likewise, President John F. Kennedy once stated, “There are risks and costs to a program of action. But they are far less than the long range risks of comfortable inaction.” If their assertions are correct, then why are so many of us content to sit back and let others carry the banner? Is it because we as pharmacists and healthcare providers are disinterested? Or do we think that the responsibility for change and advocacy rests with our employers or our professional associations? Perhaps we believe that the current status quo, including job security and a predictable paycheck, will continue to endure.

Changes in Pharmacy and Healthcare

We are already seeing trends to the contrary with a flattening pharmacist job market. The increased use of automation and centralized fill, which allows for more accurate, efficient, and economical dispensing, has decreased the need for dispensing pharmacists. A movement toward the credentialing and licensing of technicians also challenges the need for highly paid pharmacists to fulfill tra­ditional dispensing roles. Some have even suggested that the profession may see the ultimate development of a 2-class system of dispensing and nondispensing pharmacists, with a significant salary gap between the 2 roles.²

Notwithstanding the current trends, healthcare is evolving at a pace that is arguably more rapid than it has been at any other time in our history, particularly because of the implementation of the Affordable Care Act. Pressure to contain costs and at the same time improve health outcomes for our patients continues to mount. Providers across the board are held accountable through metrics that contribute to performance scores. Star ratings, for example, are assigned by the Centers for Medicare & Medicaid Services (CMS) to compare quality of care among health plans. Payment models are shifting from a fee-for-service structure to a system of bundled payments for defined episodes of care. Delivery efficiency and minimization of complications result in more robust margins for healthcare systems.

With Accountability Comes Opportunity

The emergence of accountable care organizations (ACOs) is one example of alternative payment models. CMS defines ACOs as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.”³ ACOs that deliver high- quality care and minimize costs are rewarded by sharing in the cost-savings it achieves for the program. These pay-for-performance models represent the new wave of reimbursement.

Where does pharmacy fit into the picture? The shifting healthcare paradigm not only presents challenges, but also offers significant opportunities, as long as we are versatile enough to take advantage of them. One such approach is to ensure pharmacy’s engagement with ACOs. Evidence of our ability to enhance patient outcomes and contribute to cost-savings can be quite attractive to an ACO whose margins are maximized when minimizing costs associated with quality patient care. Pharmacy needs to have a seat at that table.

Pharmacy can also positively contribute in boosting Star Ratings awarded to insurance plans. Research demonstrates that patient adherence rates on 3 separate outcome measures, including hypertension, cholesterol, and oral diabetes medications, can positively enhance an insurance plan’s Star Ratings through pharmacist involvement.⁴ Pharmacy can also enhance Star Ratings by improving the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with diabetes. Partnerships between pharmacy and health insurance plans can result in enhanced patient outcomes, elevating the health plan’s status. Pharmacy needs to share in these rewards.

Benefits of Achieving Provider Status

The Association of American Medical Colleges projects that a shortfall of more than 91,000 physicians may exist by the year 2020.⁵ Medically underserved populations and areas will be most severely impacted. One way to remedy the problem is being addressed by the introduction of the Pharmacy and Medically Underserved Areas Enhancement Act into Congress. These bills would amend the Social Security Act to recognize pharmacists as providers under Medicare Part B. Unlike physicians and the vast majority of healthcare professionals, pharmacists are not recognized as providers under Medicare Part B. Provider status would allow pharmacists to provide re­imbursable services to medically underserved com­munities consistent with state scope of pharmacy practice laws. Providing healthcare screenings, administering immunizations, engaging in collaborative care agreements, performing medication reconciliation in transitions of care, delivering medication therapy management services, and assisting patients in disease state management will not only allow pharmacists to practice at the top of our license, but will also result in the very best care that we can provide to our patients.⁶

Garnering Support for Provider Status Legislation

It is essential that pharmacists advocate on behalf of provider status legislation. The American Pharmacists Association is taking the lead on this initiative. Its website, www.pharmacist.com, offers a treasure trove of information relative to provider status. Grassroots advocacy efforts, including phone calls and face-to-face meetings with legislators, are especially effective. Alternatively, personal letters or e-mails can also serve to communicate your position. Invite legislators to visit your practice site; most do not have a full appreciation of the services that pharmacists are qualified to provide, nor do they understand the barriers that we face. Getting comfortable with advocacy is vital not only for the issues that we face today, but also for the challenges that may present themselves tomorrow.

We have a prime opportunity to elevate pharmacy practice to the full scope of our education. The challenge is to not squander this opportunity. Our silence will leave other healthcare professionals to fill the void. If not you, then who?

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References

1. Atwood M. Second Words: Selected Critical Prose. Toronto, ON: House of Anansi Press; 2005:396.
2. Romanelli F, Tracy TS. A coming disruption in pharmacy? Am J Pharm Educ. 2015;79:Article 01.
3. Centers for Medicare & Medicaid Services. Accountable care organizations (ACO). www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html. Updated January 6, 2015. Accessed March 16, 2015.
4. Leslie RS, Tirado B, Patel, BV, Rein PJ. Evaluation of an integrated adherence program aimed to increase Medicare Part D star rating measures. J Manag Care Spec Pharm. 2014;20:1193-1203.
5. American Pharmacists Association. Pharmacists and unmet need. www.pharmacist.com/sites/default/files/files/PAPCC_Unmet_Need.pdf. Accessed March 16, 2015.
6. Avalere Health LLC. Exploring pharmacists’ role in a changing healthcare environment. http://avalere.com/expertise/life-sciences/insights/exploring-pharmacists-role-in-a-changing-healthcare-environment. Published May 2014. Accessed March 16, 2015.