McKnight’s Senior Living
Orsula Knowlton, PharmD, MBA
The concept of clinical pharmacy has evolved from the passions of a handful of graduates with doctorate-level practice degrees in the early 1990s to an entirely new standard of care, with 100% of graduates with advanced degrees and direct patient care experience today.
Technology and robotic automation have assisted in transitioning pharmacy practice beyond managing prescriptions to also directly managing patients and residents. Pharmacists have three evolving roles as a result of the drive toward value-based care.
In-home medication care specialists
Medication reconciliation perhaps is the most daunting task of the care transitions process. Over the course of a healthcare event, numerous clinicians, including hospitalists and specialists, often unfamiliar with the patient / resident, prescribe medications. These medications most often are based on facility formularies that may or may not align with what the patient or resident was taking before the episode or event. Pharmacists as in-home specialists (regardless of where a person’s “home” is) have proven to be more effective than other healthcare professionals in reconciling all medication lists into one comprehensive plan.
Pharmacists can help by:
In-home measures can drastically reduce the 30-day readmission rates.
The formulary medication selection process often is based on market share/rebate incentives. Patients and residents often can be affected by business-focused contracts that result in reduced medication selection. So they may be prescribed medications that are not optimally co-administered — especially because obtaining nonformulary agents can result in delays in medication access and high co-payments.
Pharmacists can assist in the medication selection process (before dispensing occurs), helping physicians and facility medical directors find alternatives to medications that might cause drug-drug interactions or drug-drug-gene interactions. And, with pharmacogenomic data, prescribing becomes even more precise. Further, pharmacists can help avoid unintentional overdose and competitive inhibition drug interactions by providing guidance about medication administration times.
Pharmacists, who are medication experts, can help facilitate the prescribing process, especially when care coordination is lacking among providers. Involving pharmacists may even help drive the paradigm shift from formulary- and rebate-based prescribing toward a system that prioritizes medication outcomes.
Managers of medication benefits
The Program for All-Inclusive Care for the Elderly for Medicare / Medicaid dual-eligible beneficiaries is a prime example of value-based care that demonstrates how aligning incentives can eliminate the “silo effect” of Medicare Part D, which often is a cost-driver for Medicare Part A and B.
In many PACE organizations, pharmacists are able to proactively and prospectively collaborate with PACE and specialist prescribers to help optimize medication-related outcomes. In this high-risk population, pharmacists can identify whether a newly prescribed medication regimen increases a person’s risk for preventable adverse drug events. With the pharmacist in a real-time role, utilization, drug expenditures and total costs of care have been demonstrated to decrease and stabilize.
The science of “de-prescribing” is boldly confronting the problem of overprescribing. Pharmacists can advocate for both patients / residents and their insurers by optimizing regimens. This means ensuring the fewest medications required to manage chronic conditions while preserving their annual and lifetime medication benefits. Regardless of a medication’s cost, if it is the wrong medication for the patient or resident, then we’ve paid too much for it.
A systematic, prospective and personalized approach to the prescribing process can provide savings while improving clinical and economic outcomes, including patient / resident and provider satisfaction.
Overall, as value-based care moves from fee-for-service to fee-for-value, the pharmacist’s role will continue to evolve into one of responsibility for medication outcomes, as well as for the accuracy and timeliness of access.
Orsula Knowlton, PharmD, MBA, co-founded Tabula Rasa HealthCare with Calvin H. Knowlton, Ph.D. She is president and chief marketing/new business development officer. TRHC, based in Moorestown NJ , offers a suite of cloud-based software solutions to help healthcare organizations, prescribers and pharmacists better manage the medication-related needs of those in their care.
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MOORESTOWN, N.J., Dec. 12, 2017 (GLOBE NEWSWIRE) — Tabula Rasa HealthCare, Inc. (“TRHC”) (TRHC), a healthcare technology company advancing the field of medication safety, was named by Rock Health as the best performing IPO among digital health companies in 2017.
The Rock Health announcement released December 4 stated: “Tabula Rasa HealthCare provides at-risk healthcare organizations technology and services to optimize medication regimens with the goal of reducing hospitalizations, lowering costs, and mitigating risk. Tabula Rasa stock is up 140% based on YTD growth, which is the largest percent increase among public digital health companies in 2017.”
“It has been a tremendous year for TRHC in many respects,” said Chairman and CEO Calvin H. Knowlton, PhD. “Our stock has done well, indicating investors’ confidence in the company, its people, and its services. We have gained additional partners and expertise with the acquisition of Medication Therapy Management company SinfoníaRx. We also have been busy creating and deploying significant disruptive innovations, such as our recently released “Medication Risk Score”, a quick and easy way to assess which patients are at highest risk for adverse drug events (ADEs) and require medication management attention. We are pleased that these efforts have been recognized by Rock Health and their collaborators.”
Each year, Rock Health, Fenwick & West, Goldman Sachs, and Square 1 Bank award individuals and organizations for their contribution to the digital health community and healthcare ecosystem as a whole. Honorees are celebrated for their outstanding work at a dinner ceremony to be held January 7, 2018 in San Francisco during the JP Morgan conference.
About Tabula Rasa HealthCare, Inc.
Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize medication regimens to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications provide solutions for a range of payors, providers and other healthcare organizations.
For more information, please visit: www.TRHC.com.
Bob East or Asher Dewhurst