I was just on a conference call with a managed care organization (MCO) that will respond to a request for proposal (RFP) as our state shifts our medicaid administration to two or more MCOs. Unfortunately, the MCO that we spoke with today did not have any idea about the role of pharmacists as care providers. WHAT?!!!! How after all these years, with pharmacy’s movement from product distribution to patient care, can a managed care organization or payer not understand the value of pharmacists as clinical providers.
Part of the reason is because payers are not seeing this type of practice across the board. Also, not all pharmacists are practicing to the level of their degrees–identifying and resolving drug therapy problems, providing recommendations to prescribers, and documenting their activities. Lastly, payers may be looking at the wrong metrics when reviewing pharmacies (e.g. focussing on drug costs and not clinical parameters and patient outcomes, including health care spend).
As a profession, we need to do a better job of selling ourselves to payers and, in particular, our value to the health care team. Our value is that we have access to patients, we are able to identify and resolve drug therapy problems, we can ensure that patients are on safe and effective medications, and most importantly, we can make sure patients are achieving therapeutic outcomes–which will positively affect their total health care spend.
But all pharmacists also need to step up their efforts to develop and implement patient care services if they have not already done so. There is no money in product distribution because there is little value from patients and payers. The value statement is patient care, achieving health outcomes, and the unique role and knowledge of pharmacists to monitor and manage patients drug therapy. So, we need to make this the “norm” of pharmacy practice–not the exception.
Pharmacists, as a group, also need to be more vocal about the clinical roles to payers, legislators, and regulators. We cannot just sit on the sideline hoping that someone can figure this out–each of us has a responsibility to advocate for our profession–to reach out to payers and let them know what you are doing and the value you bring to their clients through your patient care services. If we do not do this, our profession will continue to experience the response that I experienced today–and that is getting old!!!
