Physician CEO pushes to include pharmacists on clinical team

Abstract

Thomas Raskauskas, MD, President and CEO of St. Vincent’s Health Partners (SVHP) in Bridgeport, CT, perked up when he read a December 12, 2013, CEO Blog post from APhA Executive Vice President and CEO Thomas E. Menighan supporting the proposed Grassley– Carper amendment to the “doc fix” bill in Congress that sought to add pharmacists to the list of recognized providers in accountable care organizations (ACOs). Thomas Raskauskas, MD, President and CEO of St. Vincent’s Health Partners (SVHP) in Bridgeport, CT, perked up when he read a December 12, 2013, CEO Blog post from APhA Executive Vice President and CEO Thomas E. Menighan supporting the proposed Grassley– Carper amendment to the “doc fix” bill in Congress that sought to add pharmacists to the list of recognized providers in accountable care organizations (ACOs). Raskauskas immediately picked up the telephone and called Menighan, BSPharm, MBA, ScD (Hon), FAPhA. He wanted to let him know, Raskauskas told Pharmacy Today, "that we've got a team up here in Connecticut that's doing just that." And, indeed, using pharmacists to help respond to what Raskauskas called "gaps of care" has been central to SVHP's collaborative approach since its launch in May 2012 as a clinically integrated network, similar in structure to an ACO. Formed by a diverse group of some 275 Bridgeport-area primary care physicians and specialists and the city's 473- bed St. Vincent's Medical Center, SVHP currently has three insurance contracts covering approximately 14,000 individuals and families who live or work in the Greater Bridgeport area. One contract includes approximately 4,000 Medicare fee-for-service beneficiaries who go to doctors within the SVHP network. A second, also covering about 4,000 individuals, is with Anthem Blue Cross and Blue Shield. The third is St. Vincent's Medical Center's self-insured plan, which covers approximately 6,000 employees and their families. In February, SVHP became the nation's first physician-hospital organization to receive clinical integration accreditation from URAC, the Washington, DC-based accrediting organization. Raskauskas said that many of the physician-hospital networks created under the Affordable Care Act have failed to include pharmacists on their clinical teams, but "the more we look at the problems and the reasons for high costs and readmissions, the more we realize that they are related to what pharmacists deal with on a day-to-day basis." "The problems and the reasons for high costs and readmissions are related to what pharmacists deal with on a day-to-day basis." SVHP has several solutions for leveraging the "scarce resource" that pharmacists represent, according to Raskauskas. For one, he said, pharmacists are used in a kind of "academic detailing" approach to advise physicians on safe and effective alternatives to more expensive drugs, including not only approved generic options but also evidence-based therapeutic equivalents within the same medication classes. At SVHP, pharmacists monitor patients' prescriptions to make sure that they are picked up promptly. Prescriptions are also often delivered at home or to work sites to achieve the same rapid response to therapy. The aim is to prevent complications and costly readmissions, said Michael Hunt, DO, Chief Medical Officer and Chief Medical Information Officer at SVHP. "When patients go home at the end of the day," he said, "they don't always know how to use their drugs appropriately or understand completely why they're taking them." Having a pharmacist on the team can help fill those knowledge gaps, Hunt said. A pharmacist can also detect interactive or duplicate therapies, he added, which is particularly important for patients on multiple medications prescribed by different physicians. MORE ONLINE■APhA's CEO Blog: www.pharmacist.com/CEOBlog/provider-status-game ■APhA's CEO Blog: www.pharmacist.com/CEOBlog/provider-status-game On the inpatient side, the hospital has instituted a "meds to beds" program that gives patients the option to have their discharge medications delivered to their bedside by a pharmacy technician. Additionally, a pharmacist is available by telephone to answer any questions that arise. The telephone connection will soon be replaced by a telehealth system that allows a pharmacist in a central location to interact directly with patients via an in-room television screen. Raskauskas said SVHP is also "working with our hospital partner" to have all of the network's hospital-admitted patients obtain medications at discharge, have their drug lists reconciled, and receive medication therapy counseling. In the future, SVHP is looking to expand its pharmacist integration program. "We want to work with pharmacy schools and pharmacy residency programs to have trainees come and learn what we're doing in population health management and then go on to duplicate what we're doing," said Raskauskas.