When Cindy* came home to recuperate after a hip replacement, a relatively new member of her primary care provider’s team – the pharmacist - was ready to follow up.
Within hours of her discharge, pharmacist Bethany Spadaro called to find out how she was doing. She was having trouble breathing. Spadaro learned Cindy had not been taking the anticoagulant medication her surgeons had prescribed to keep her blood from clotting. That was a red flag.
Spadaro told her: “You have two choices: go to the ER, or come to our office, now.” She came to the office, and a simple X-ray of her lungs found two blood clots. Left untreated, they could have stopped her heart.
Embedded pharmacists enhance care for patients with chronic conditions
Bethany Spadaro is one of five pharmacists Blue Cross & Blue Shield of Rhode Island (BCBSRI) embeds in primary care practices throughout the state. Tara Higgins, a clinical pharmacy director, leads the effort. She says the pharmacists become part of the primary care doctors’ teams, providing additional expertise and support for patients with complex medication regimens and health conditions. The pharmacists are not always handling emergencies. They are also advising patients about taking high-risk drugs safely, avoiding drug interactions and managing chronic conditions.
Higgins says diabetes is a great example of how embedding pharmacists in a primary care physician’s practice delivers better care and ends up being more cost effective.
“Primary care physicians are increasingly handling diabetes care,” says Higgins, because of rising rates of the disease. “But they also appreciate the time and skill it takes to initiate and monitor that kind of care.” With a pharmacist in the office, a doctor can ask that pharmacist to visit the exam room before a patient even leaves. Each pharmacist in the program is a certified diabetes educator. They can begin the labor-intensive process of starting patients on a medication regimen in the office, rather than referring them to a specialist, which could mean more out-of-pocket costs for a patient.
“The pharmacists know how to choose a drug that’s most effective for a patient’s condition and preferences, as well as which drugs are on BCBSRI’s preferred medication list,” says Higgins, all of which could save a patient money without sacrificing the highest quality care. Without a pharmacist, a physician might want to see a patient newly diagnosed with diabetes every month to adjust medication. In this model, a pharmacist calls once a week to check in on patients, educate them about how to test their blood sugar and take their medication. The pharmacist can also work with physicians to make quicker adjustments when needed.
Improving medication adherence, reducing risks
Having a pharmacist on the team is more than just a convenience for patients and doctors. Research from the Annals of Internal Medicine shows that about half of the medications prescribed for chronic diseases aren’t being taken as directed. Researchers estimate that not adhering to a prescribed drug regimen causes approximately 125,000 deaths annually and at least 10 percent of hospitalizations in the U.S.
BCBSRI’s embedded pharmacists are helping to reduce those risks. Adherence rates for diabetes, hypertension, cholesterol and depression medications have increased year over year, approaching or exceeding a goal of 88 percent among BCSBRI patients. Fewer elderly patients are on unnecessary, sometimes risky, medication for their age. And the percentage of patients receiving a comprehensive medication review has gone from just 19 percent in 2014 to 81 percent in 2018.
Mike Kolodij, PharmD, heads BCBSRI’s pharmacy programs. He’s a pharmacist by training, and he believes pharmacists are better positioned to help patients directly, in more settings, than ever before. Pharmacists, he says, have long since moved beyond simply counting and labeling medications. But, says Kolodij, “they have traditionally never been reimbursed for additional services like advising.” Now, he says, they’re increasingly able to use their specialized training to do just that.
Embedded pharmacists are not only improving patient health, says Kolodij. They’re saving patients money and keeping costs down overall. “Since the program’s inception five years ago, nearly $37 million dollars in costs have been contained or avoided,” says Kolodij. Some of the savings come simply from streamlining or adjusting a patient’s medications to improve their health and make managing a chronic condition that much easier.
*We’re not using this patient’s real name to protect her privacy.
Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.