By Katherine H. Capps, Co-Founder and Executive Director, GTMRx Institute
April 22, 2020
Make COVID-19 “all hands on deck” more than a rallying cry
“All hands on deck!” has been the call to action over the last several weeks.
And health care workers are indeed putting themselves “on deck.” But there’s a problem. It’s certainly not our brave health care workers; it’s the health care delivery system—broken and wounded.
COVID-19 has revealed to everyone what those of us working in health care transformation have long known: The structures we have in place to deliver and pay for care are crumbling.
Our siloed, delivery system, built on a fee-for-service chassis, does not respond well to demands that call for an “all hands” approach to patient care at a population health level.
Perhaps pushing the system beyond the breaking point is what it takes. COVID-19 has forced payors, health care systems, regulators and others to consider innovative approaches to diagnosis, treatment and management of populations. New treatment models, technologies, diagnostics and communication tools are coming into play, and we are finding an open-mindedness to solutions at the point-of-care that were previously impossible to introduce to our medical-industrial complex.
The kicker? These innovations have been around for years, but they’ve largely been languishing on the drawing board. Until now.
We’re seeing increased demand, necessitated by workforce scarcity, of team-based care and reimagining who is considered a critical member of the team. Granted, these changes are incremental—and so far, only temporary. But we are getting an interprofessional team of hands on deck.
And those hands include pharmacists.
Liberating the pharmacists on board
Steven Chen, PharmD, FASHP, FCSHP, FNAP, of the University of Southern California School of Pharmacy, addressed one aspect of this in a recent piece for The Conversation. It was entitled “US pharmacists can now test for coronavirus—they could do more if government allowed it.”
Pharmacists could have been a first point of contact for people who thought they may have been infected but weren’t seriously ill. But only recently were they granted that authority.
Pharmacists could play a much bigger role, he writes.
“With the proper precautions, pharmacists can offer drive-up testing and evaluation services that allow patients to remain in their cars, and they can provide selective home visits for those who are quarantined or self-isolated. Pharmacists can also refer patients for further medical care when needed.”
And, as Steve points out, it would allow access points to “manage the pandemic in the community, not in hospitals and emergency rooms.”
We know this: Teams that includes pharmacists will improve outcomes during and after the pandemic.
Steve—who is a GTMRx Distinguished Fellow—offers several examples of how the addition of a clinical pharmacist to the care team improves outcomes.
“Advanced services, such as comprehensive medication management, provide an individualized evaluation, and pharmacists providing CMM can adjust medications in partnership with physicians and follow up with patients until treatment goals are reached. With strong links between common diseases, such as high blood pressure, diabetes and asthma, and complications from COVID-19, these services are more important than ever.”
This team-based, patient-centered approach improves patient care by optimizing the skills of everyone on the care team. Clinical pharmacists become integral members, working collaboratively with the physicians, nurses and other providers.
We know it works. Adding a clinical pharmacist to a care team improves outcomes, lowers costs and reduces physician burnout.1 Physicians are freed up, allowing them, according to GTMRx President Paul Grundy, MD, to “focus on difficult diagnostic dilemmas, other acute issues, delegating medication management issues to the medication expert—the clinical pharmacist”.
Change is coming, but not fast enough
Steve recognizes the opportunity for change, and so do we: “In a number of programs across the country, pharmacists have shown that they can dramatically improve control of medical conditions, avoid the need for hospital admissions and reduce health care costs.”
He’s right, of course. The pandemic-related scarcity of health workers points to an opportunity, and clinical pharmacists should be called upon to perform what they are trained to do. As we move past this pandemic, we should continue to ask how we effectively align and reward these teams on an ongoing basis to support quicker access to diagnostics and a more rational approach to medication use, and in what way our payment policies should be redesigned to support team-based, person-centered care.
So yes. We need all hands on deck today and after the pandemic subsides. We must remove payment and policy barriers that prevent key health care professionals from actually reaching the deck.
Steven Chen is slated to talk about the pharmacist in advanced practice roles in an upcoming episode of Freakonomics.
1. Funk KA, et al. “Primary Care Providers Believe That Comprehensive Medication Management Improves Their Work-Life.” J Am Board Fam Med. 2019 Jul-Aug;32(4):462-473