Improving Access to Essential Medications and Healthcare Services
Melissa Mook, R.Ph., Stephen Ruenroeng, Pharm.D., Nichole Rineer
WellSpan Pharmacy and Healthy Community Pharmacy, WellSpan Health, York, Pennsylvania
Rising costs associated with the provision of discounted medications to low income, uninsured patients created a need to reassess and improve the overall care of this patient population. The cost to WellSpan Pharmacy to provide medications to 2400 patients in this population annually exceeded $1 million in fiscal years 2003 and 2004. Healthy Community Pharmacy, a charitable, specialized, community pharmacy, was established in August, 2004 in order to improve access to medically appropriate, affordable medications.
The pharmacy model includes multiple sources of medications for patients, on-site financial caseworkers, and therapeutic substitution and disease state management programs. This model creates a patient-centered, access-oriented service for both patients and providers. As each patient presents for care, medication orders are reviewed by a clinical pharmacist for accuracy, affordability and appropriateness. Each medication is provided to the patient through one of three avenues:
- Direct sale of inexpensive generic medications
- Provision of donated medications
- Pharmaceutical manufacturer patient assistance programs
Caseworkers work with patients to determine their eligibility for available state and federal insurance programs. This model creates an opportunity for outpatient pharmacists to directly impact the care of patients. It maximizes available technology, networks pharmacists with other healthcare providers, and gives pharmacists an opportunity to participate in disease state management efforts.
The development of a network of providers and community action agencies, combined with the establishment of the pharmacy, has created documentable improvement in patient access to medications, management of chronic diseases, and reduction in cost of care. The number of patients accessing medications has increased 26% from fiscal year 2002 to 2006. Patient satisfaction is high at 96% for pharmacy services. Disease state management programs are provided to the population. Results have shown improvement in compliance and clinical indicators. Prior to disease state management efforts, Hemoglobin A1c results were available for only 12% of diabetic patients. After enrollment, 63% of diabetic patients have Hemoglobin A1c testing completed. Emergency department visits per member per month decreased an average of 0.005 from 2004 to 2006. This equates to a savings of 16.8 emergency department visits per month. Using cost figures from WellSpan Health where the average emergency department visit charge for fiscal year 2006 was $1,141.14, an expected savings to the health system of $230,054 per year was extrapolated. By fiscal year 2004, the for-profit, outpatient pharmacy corporation was sustaining losses approaching $400,000 annually in meeting the medication needs of the uninsured. With the opening of the new pharmacy, overall financial performance improved, equating to a $198,000 positive shift in net income in 2005. These results were sustained in fiscal year 2006, with an improvement of $185,000.
By leveraging the unique expertise of several health care providers and community agencies—including hospitals, physician groups, a pharmacy, a federally qualified health center, community action groups and a managed care company—the low income, uninsured patients of one community now have access to clinical pharmacy services, affordable medications, and coordinated, high-quality healthcare.
View a pdf of the poster from the Midyear Meeting (400KB).