Medical Home Onsite Pharmacist Program Successful
Fewer than 12 months after an old insurance company decided to start funding pharmacists in six patient-centered medical homes, Blue Cross and Blue Shield of Rhode Island has decided that the program is successful and is planning to expand it.
According to Beth Herbert-Silvia, Assistant Vice President of Pharmacy, the company is looking at $2.1 million in savings through the patients in a pharmacist program for the first half of 2015.
The savings are partly from switching patients to drug therapies that are less costly for the company. They also save money by avoiding preventable medical costs, such as those for treating anaphylactic reaction to a drug for which a patient is known to have a severe allergy. These types of things are more likely to occur if the pharmacist is not there to intervene.
Blue Cross and Blue Shield of Rhode Island’s Medicare advantage plan two years ago had a summary rating of 3.5 stars, for the measures related to its prescription drug benefit according to data available from the Centers for Medicare and Medicaid Services (CMS). This data included the plan’s performance on measures pertaining to high risk medication and medication adherence for a variety of drugs including oral diabetes drugs, statins, and renin-angiotensin system antagonists.
Last October, before open enrollment for the 2015 season got underway, the plan had a summary rating of 4.5 stars for the prescription drug benefit with an overall rating of four. As such, the Blue Cross and Blue Shield of Rhode Island received a CMS designated quality bonus payment of 5% of the plan’s 2015 payment.
Near the end of October last year, the company announced it would expand the onsite pharmacist program beyond the pilot site to add five additional practices. As such, they are now expecting 4.5 stars or better for this year in regards to the plan’s prescription drug benefit.
Member engagement with the pharmacists has reached 69-100%, surpassing the level at which the company considers the program successful. That high level of engagement shows how well these pharmacists have been able to go into these group settings of care to establish the necessary collaborative relationships to become the sole provider of pharmacy services.
By the end of the year, the health insurance company will have 10.5 full time pharmacist equivalents working in these patient-centered medical homes. The point size comes from the work of a pharmacist who is focusing on chronic kidney disease working with a subspecialty group of nephrologists to take a patient centered medical home like approach to patient care.