Standards and Technology Supports the Growing Role of Pharmacists in the Care Team and the Shift to Value-Based Agreements

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iStock-1214910613-modifiedFor a host of good reasons, the role of the pharmacist continues to expand in healthcare. Pharmacist have long been highly trusted by patients and as recent as January 18, 2022, more than 79% of patient respondents found pharmacist to be reliable and 90+% expressed a high level of trust.

Given the community presence, pharmacists are also in a unique position to meet patients where they are. For this reason, many pharmacists and pharmacies are taking on more responsibilities and continue to move toward more direct patient care responsibilities and away from historical “transactional” care. This shift supports healthcare’s transition to value for care vs fee for service.

Regulators and employers certainly have their eye on the delivery of value over volume or value-based care (VBC), transparency, interoperability, and data sharing. Standards Development Organizations (SDOs) such as the National Council for Prescription Drug Programs (NCPDP) and Health Level Seven (HL7) continue their work to harmonize each other’s’ standards development efforts in support of patient care (eCare plan) and patient specialty medication access.

For pharmacies to successfully expand their role and enter into value-based arrangements, they will have to transform their business models. Pharmacies will need to adopt and use emerging technologies and standards to enable real-time communication with other providers and payers or plans vs. PBMs. Pharmacy system vendors must be able to translate current and emerging NCPDP standards to interact and be consumable within APIs and FHIR APIs, assuring consumption by EHRs and payer/plan systems.

Another factor pharmacies need to consider is that the pharmacy of the future is here. Consumers have an ongoing expectation to have the option for telehealth and telepharmacy. Pharmacy margins are eroding with growing competition from mail order and digital pharmacies. The time for pharmacies to act on transforming their business is now. This strategy requires considerable change in mindset and truly transforming their overall pharmacy services business model or at least a portion of their overall delivery model. Pharmacist are positioned, as clinicians to provide encounter and clinical care - 53% of US-licensed pharmacists are Doctors of Pharmacy– but also need to assure systemically they can provide the care in a multitude of settings via emerging tech (telepharmacy) – in-home care as well as in the community (More statistics like this can be found in the 2019 National pharmacist workforce study.) This will require bringing the patient’s health record into the pharmacy system as well as encounter details, such as A1c, blood pressure, vaccination and more to be transmitted from the pharmacy back into the EHR via emerging interoperable technologies (standard API, FHIR API).

The bottom line? We suggest that pharmacies need to engage in these initiatives so their end-products will accurately reflect the realities of the evolving patient care landscape, meet its day-to-day and long-term strategic growth needs and accelerate progress that’s already being made by supporting pharmacists as partners in value-based contracts including the real-time sharing of clinical or encounter data and outcome data. Our previous blog on this subject, titled “Four Reasons to Become a FHIRmacy,” provides additional background.

A couple of examples of how to get involved, along with the reasons to do so:

  • Get Active in NCPDP. NCPDP, whose standards are already used by most ambulatory and acute care pharmacies for electronic prescribing, billing, dispensing, inventory control and other functions has task groups individuals can join which provides a forum to share insights into workflows and current challenges that standards may be able to address.

NCPDP standards will continue to play a key role for many vital pharmacy functions, but compatibility with FHIR – which is becoming the gold standard for real-time communications and access to data – will be indispensable for pharmacists who want to engage as value-based providers in the emerging new era of interoperable healthcare.

Some software systems, especially ambulatory pharmacies, have been hesitant to get on the FHIR train; however, there is an ever-growing educational process happening. NCPDP continues to engage and outreach to the pharmacy community, such as the recent PTI Accelerator Round Table Discussion NCPDP Standards and HL7 FHIR, creating a forum for pharmacies and their partners to have a clearer understanding of the need for change and change management processes related to pharmacist and value-=based arrangements.

  • Participate in Pilots. Initiate or join a pilot project that aims to connect pharmacy systems – using FHIR and NCPDP standards – with those of healthcare providers, vendors, and related organizations. There are many such efforts, and POCP can assist pharmacies in identifying which might be a good fit for them. One immediate opportunity is to apply by April 29 for a grant from the NCPDP Foundation, which is seeking to fund initiatives that show the value of standards to support patient safety, access to care, and the expanded role of pharmacists.

  • Engage in Pharmacy Quality Metric Conversations. Get involved with organizations like the Pharmacy Quality Alliance and help to shape and inform the pharmacy quality measure development, including but not limited to measurements related to value based care and arrangements.

There are many ways pharmacies and pharmacy software organizations can get involved and lend their perspectives and expertise helping to shape the future of pharmacist engagement and the delivery of patient care, including the standards development process, improving interoperability between the pharmacy setting and more traditional care settings. If your organization needs help in creating or adjusting transformation plans to better respond to the changing market and technical and regulatory landscape, reach out to kim.boyd@pocp.com to set up a time to chat.