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THE INTEGRATION OF pharmacy and medical data has gone a step further into the coordination of services. A whitepaper published
in March 2009 by several pharmacy organizations attributes a new focus on collaboration to an uptick in clinical consequences
and costs of medication misuse and non-adherence; a shift from acute to chronic care; the increasing role of pharmacists;
and the growing number and complexity of medications.
"Coordinating pharmacy and medical benefits paints a total picture of compliance without a gap in data, and thus, impacts
outcomes," says Nita Stella, senior vice president, ActiveHealth Management, a care management company headquartered in New
York City. "In addition, sharing information can increase medication safety and effectiveness by triggering alerts to flag
drug-to-drug interactions, contraindicated drugs and non-compliance."
Integration is an effective vehicle for identifying high-risk members and putting value-based benefit design into place. For
example, an integrated system could identify high-risk members and lower copayments for those individuals or for an entire
class of drugs, such as stains, to encourage compliance.
David Dross, leader of the managed pharmacy practice for Mercer Inc. in Houston, says that integration is easier if one vendor
is managing both sides of the equation. While he believes that a carve-out pharmacy is willing to share its data, he says
the medical vendor could be the "fly in the ointment" because there may be a fee attached to the provision of data. The Clinical Pharmacy Cardiac Risk Service (CPCRS) at Kaiser Permanente Colorado combines KP HealthConnect, an electronic
health record (EHR), with an electronic care registry, proactive patient outreach, wellness and medication management.
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After high-risk patients for coronary artery disease are identified, they are referred to CPCRS. The program has served 21.000
patients since 1998.
"We are able to determine who has a cardiovascular event and deliver continuity of care cost-efficiently by integrating pharmacy
and nursing teams with patients and their doctors and using technology and other tools to address problems," says Jon Rasmussen,
chief of clinical pharmacy, cardiovascular services. "Primary care physicians and cardiologists spend an inordinate amount
of time with chronic care patients, so we're looking for ways that pharmacists and nurses can relieve some of the burden.
If these cardiac patients are managed consistently through collaboration, that frees up physicians to address acute issues."
Results show the number of those meeting their LDL cholesterol goals increased from 26% to 73%, and screening for cholesterol
rose from 55% to 97% during an average length of participation in the program of 2.3 years.
In addition, participants in the CPCRS program had an 88% reduced risk of dying from a cardiac-related cause when enrolled
in the program within 90 days of a heart attack.
When members are close to release from the program, Kaiser Permanente rehabilitation nurses set up phone calls to discuss
diet, exercise, depression, smoking cessation and medications. In a seamless process, Rasmussen says, after discharge, participants
work closely with clinical pharmacists for long-term medication management.
Although the program has been successful by saving lives, reducing hospitalizations and recouping investment, it hasn't been
without its challenges. Among them have been getting clinicians to communicate via the EHR, developing multifunctional teams
and making sure that "we target the right person with the right treatment at the right time," he says.
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