(Management Case Study) Prescribing Value: Defining the Population Health Pharmacist Role in a Value-Based Care Model

Purpose: Accountable care organizations (ACO) rely on healthcare teams for value-based care. Pharmacists are integral members, historically addressing medication management with inconsistency regarding quality metrics and total cost of care. Lack of awareness for multifaceted pharmacist roles has caused disjointed efforts to incorporate. Without a defined position on the population health team, we have missed opportunities to enhance outcomes and patient care. Pharmacy personnel can play a pivotal role as they are well positioned to consume data and translate it into initiatives promoting health of populations and value-based prescribing practices.

Methods: Our goal for the pharmacist, as a crucial member of the population health team, was to work to promote value-based medication use with efforts focused on slowing disease progression, improving health-related outcomes, and decreasing total cost of care. Medication value in the organization was advocated for through the lens of payor identified clinical quality measures, total cost of care considerations, and clinical decision support. This work was largely accomplished through direct and indirect patient care, payor and provider collaboration, and development of tools and resources to promote value-based medication prescribing. Beyond the interprofessional population health team, the population health pharmacist is a liaison to specialty pharmacy, pharmacist clinicians, retail pharmacy, and medication use access services, and utilized these relationships to reach shared goals for patients and the organization.

Results: As an accountable care organization, providing coordinated, high-quality, cost-effective care is an emphasis for all patients. Utilizing these strategies to meet quality targets outlined in value-based contracts was a building block for the population health pharmacy team model. The focus on quality metrics pertaining to guideline-directed care and medication taking behaviors improved patient outcomes and compliance within value-based contracts. This also developed relationships with providers in the organization to further conversations promoting medication value. Total cost of care discussion and workflow has been created through alerts and reports for high cost medications, biosimilar care pathways, cost saving clinical rule evaluation, and site of service considerations. Putting these aspects together for a broader view of the population as a whole has allowed for work upstream and creation of decision support tools for patient and provider benefit.

Conclusion: A dedicated and defined pharmacist role on the population health team allows for enhanced clinical outcomes and patient care. Beyond traditional pharmacist scope, this has developed payor and provider relationships, created workflow and clinical decision support tools, and focused on medication value as part of total cost of care considerations.