The study found that using pharmacists’ databases to improve compliance, diagnostic accuracy, and prescription appropriateness can save money for health plans. This concept enhances of the professional role of the pharmacist, placing him or her squarely within an integrated system of care.

“The use of pharmacists in this way certainly would be a substantial advantage to health plans within the medical home concept,” said Paul Keckley, PhD, director of the Deloitte Center for Health Solutions, who cowrote the report, titled "Disease Management and Retail Pharmacies: A Convergence Opportunity." “They could have a paid role as care coordinators, with associated potential savings for health plans.”

The basic idea is to improve quality —thereby reducing overall health costs— by getting the right drug to the right patient at the right time. Medicare, some health plans, and drugstore chains are looking at the idea, basically as an expansion of medication therapy management services, Keckley said.

“Pharmacists already have access to a patient’s drug history, including over-the-counter medications, through insurance data,” he said. “This data can provide a strategic advantage in disease management, an advantage that is currently underutilized. The goal is to provide patients with both preventive and curative care in a coordinated fashion. Pharmacists fit naturally in that model, as the medication management professionals.”

Right now, “scalability makes the concept most attractive to chains,” Keckley added. “They can profitability coordinate the sort of DM services now available from some primary care physicians, such as medication reminders and coordination of care for chronic conditions. But pharmacists have ready access to the databases that could provide indispensable information for coordination within a medical home.”

The “medical home” concept Keckley refers to is changing the current DM model. It is endorsed by professional organizations such as the American Academy of Family Physicians and the American Gastroenterological Association. Essentially, it refers to a delivery system in which individuals use primary care practices as the basis for “accessible, continuous, comprehensive, and integrated care,” said Keckley — in essence replacing the DM vendor.

“Pharmacists certainly have the skills, training, and knowledge to be prime players in a coordinated approach,” said Judy Cahill, executive director of the Academy of Managed Care Pharmacy. “An inherent shortcoming to this idea, however, is lack of pharmacist access to patients’ medical records. For them to play a pivotal part in care management, the medical record is essential.”

Keckley agrees. Lack of pharmacist access to patient medical records currently limits the role of pharmacist to medication management only, rather than offering an opportunity to manage care between patients and providers, such as nutritionists and physical therapists, he saids.

Two developments can change that: the increasing use of electronic medical records and the industry-wide promotion of electronic prescription transmission. EMRs will allow pharmacists access to diagnostic rationales and long-range patient treatment histories. For example, an EMR can give pharmacists access to laboratory data. HIPAA privacy concerns may have to be addressed through authorization forms, and state boards of pharmacy may have to reexamine current regulatory practices.

But these concerns are already being addressed through medication therapy medication initiatives across the country — many sponsored by health plans that see a cost advantage in having pharmacists counsel patients. E-prescribing not only gives pharmacists access to insurance information — data available through pharmacy benefit management software — it also enhances communication with physicians.

Several emerging e-prescribing models, sponsored by health plans, include e-prescribing as a component of EMRs. “Bring into that the use of clinical management tools, which are the tools that DM companies now market, and pharmacists will be able to offer a degree of coordination, especially for patients with chronic diseases, that no other provider, including physicians, are as readily able to provide,” said Keckley. “Plans could consider paying for that service.”

“There is great potential for pharmacists as care coordinators,” agreed Cahill. “That’s part of the promise that medication therapy management holds for the quality of care.”

“There is a huge set of costs associated with lack of proper medication mismanagement,” said Keckley, “resulting from wrong doses, drug-drug complications, or even bad handwriting. Focusing on medication management as a core element of disease management, something pharmacists at the retail level are professionally prepared to do, could improve the accuracy of diagnosis and the appropriateness of scripts, and improve patient adherence.”

According to the Deloitte report, as Medicare and commercial plans shift to pay-for-performance programs, requiring provider organizations to invest in information technologies and operating models that focus on patient care management, major national pharmacy chains, including Walgreen, Longs, CVS, and others with adequate capital, will begin offer DM services. It is already being done with physicians.

Keckley says that payers such as Aetna, CIGNA, and United Healthcare already reimburse retail clinics for primary care services and seek to encourage less costly care settings. “Reimbursement for disease management services will be accepted by commercial plans and tested by Medicare via pilot programs,” Keckley said. “It’s already happening. Placing pharmacists into that scenario is not a big jump.”