Patient Centered Medical Home: Developing, Expanding and Sustaining a Role for Pharmacists
Hae Mi Choe, Pharm.D., CDE, Stu Rockafellow, Pharm.D., Trisha Wells, Pharm.D., Tami Remington, Pharm.D., Leslie Shimp, Pharm.D., Heidi Diez, Pharm.D., Annie Sy, Pharm.D.
University of Michigan Hospital and Health Systems, Ann Arbor, Michigan
The overall purpose of our program was to form a partnership between the Health System's Department of Pharmacy, the College of Pharmacy, and the Physician Group Practice with the goal of integrating clinical pharmacists into the Patient Centered Medical Home (PCMH) model at the University of Michigan Health Systems.
In 2009, Blue Cross Blue Shield of Michigan (BCBSM) provided financial incentives to physician groups to implement PCMH principles within their practices. BCBSM, along with other payers, also began paying for achievement of quality indicators for chronic disease management. These forces provided an opportunity to develop a reproducible model of direct patient care by primary care pharmacists in which their processes of care were standardized across multiple sites. The rationale was that PCMH pharmacists could assist in managing chronic conditions by substituting and/or augmenting physician care, help achieve quality indicators, and increase revenue by billing for their services. PCMH pharmacists at the University of Michigan currently provide direct patient care services at ten general medicine/family medicine health centers for patients with diabetes, hypertension, hyperlipidemia, and poly-pharmacy via referral from physicians. With the implementation of this program, we created a new reimbursement system for the pharmacists’ services. Pharmacists generate revenue for the health centers by billing T-codes which are payable to the University of Michigan Health System by most BCBSM and Blue Care Network insurances.
The total number of unique patients seen by PCMH pharmacists in year one was 949 patients. The number of unique patient encounters ranged from 43 to 232, while the number of patients per-half day clinic ranged from 2.2 to 6. The number of PCMH pharmacist-run half-day clinics in each health center varied from 1 to 6. The majority of patients seen by PCMH pharmacists at most of the health centers had diabetes. Overall, patients with a baseline A1c > 7.0% (n=270) experienced a mean decrease in A1c of 0.8% (95% CI 0.6 to 1.0, p<0.001). Higher risk patients with a baseline A1c > 9.0% (n=118) experienced a mean decrease of 1.4% (95% CI 1.1 to 1.8, p<0.001). Pharmacists in four of the PCMHs made more medication changes per visit than the other four, particularly for patients with diabetes. PCMH pharmacists generated $154,831 in revenue via T-codes and $196,000 from the health centers in year one.
Partnerships among departments and leadership with a common vision were vital to the initiation and expansion of the PCMH pharmacists’ involvement in the PCMH model of care. Developing a consistent model of direct patient care for all PCMH pharmacists has been critical to support expansion and sustainability.
View a pdf of the poster from the Midyear Meeting (877 KB)