There is a growing body of research on the pharmacist’s role in population health management initiatives and the need for pharmacists to be involved in the development of personalized care plans, coaching, education and the delivery of patient-centered care.
As many population health efforts focus on complex patients with multiple chronic diseases, effective medication management can be key to these efforts, and pharmacists stand to play an integral role in improving medication use, adherence and outcomes, according to many healthcare leaders.
Leaders at Beth Israel Deaconess Care Organization (BIDCO), a value-based physician and hospital network and accountable care organization (ACO) in Massachusetts, have made efforts to give pharmacists a bigger role in preventive care to provide more intense medication management, with the aim of achieving improved outcomes in less time than traditional approaches.
BIDCO has 2,600 participating providers, both primary care providers and specialists, across its network and partners with seven community hospitals and one academic medical center, Beth Israel Deaconess Medical Center, a major teaching hospital of Harvard Medical School. About 20 percent of physicians in the ACO are independent, while the majority are employed by their respective organizations. BIDCO also is contracted with the Centers for Medicare and Medicaid Services (CMS) as a Medicare Shared Savings Plan (MSSP) participant.
Sarika Aggarwal, M.D., BIDCO’s chief medical officer, says the organization works with providers in five key areas. “We are their structure to do contracts with the payers, both commercial and government payers. We create the internal financing systems for all of our providers. We do administrative functions and we also have data analytics and a population health tool with a data warehouse across all our providers, and that is a pretty big feat because we have several different versions of electronic health record (EHR) systems. Finally, we create the population health strategy based on these value-based contracts that we have, so we create the clinical strategy and we execute on the strategy within the structure of BIDCO.”
Bill Gillis, CIO at BIDCO, will share more insights on the role of data and analytics to support risk-based contracts at the Health IT Summit in Boston on August 7 and 8 at the Courtyard Boston Downtown.
As part of a population health strategy, many healthcare organizations focus on behavioral changes to improve health outcomes. However, it can take months, if not years, before providers see measurable results from their efforts. In an effort to get pharmacists more involved in the organization’s population health work, BIDCO leaders deployed a unique “pharmacy first” approach specifically to its Rising Risk Management program.
“There is a lot of evidence that speaks to pharmacists having a much bigger role in population health, and especially in the chronic disease space. I think pharmacists, in the future, are going to be very valuable independent practitioners because they are able to effect the key pieces in population health—medication adherence, medical management and the quality management of these chronic diseases,” Aggarwal says.
When Aggarwal joined BIDCO in 2016, pharmacists participating in the ACO were helping to address quality gaps in care focusing on patients with chronic diseases and multiple medication regimens. At that time, a small pilot project focusing on improving medication management for diabetes patients was proving successful. “Given the size of our network and the size of our population, my vision was to touch a greater number of lives, so I wanted more patients to be enrolled in this program,” Aggarwal say. “I also knew that there was a whole behavioral management piece that needed to be added to the pharmacy piece. And, another key aspect is that I wanted the pharmacists to lead this because I thought they could bring all of this together.”
Beginning in 2017, BIDCO clinical leaders move forwarded with this “pharmacy-first” approach to its rising risk management program, which entailed risk stratifying the “rising risk” patients as well as hiring and training health coaches and engaging physicians in this work.
“We realized there was a lot of opportunity, really looking at our populations and focusing on which diseases we could have the biggest impact, and then thinking about the medication piece—how medications really fit into each one of these chronic diseases,” Jennifer Perlitch, BIDCO's rising risk, program manager, says. BIDCO leaders settled on five chronic diseases to focus on—diabetes, asthma, COPD (chronic obstructive pulmonary disease), cardiovascular disease and heart failure. “We spent a good amount of time focused on what our strategy would be and really structuring our interventions with these patients to incorporate what the patients wanted to work on, but also influencing them to focus on key pieces with regard to self-management that could really impact them now, as well as reduce the likelihood of disease progression and exacerbations or complications in the future,” Perlitch says.
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