Primary Care and Pharmacy Care: A Roadmap for Health
By Cathy Kuhn, PharmD, FAPhA, HIMN President and Chief Pharmacy Officer
Within evolving research into how a primary care health system of tomorrow might function, it is imperative to include pharmacists among the providers who are key clinical leaders. Reviewing a recent New England Journal of Medicine (NEJM) commentary, there are ample opportunities for pharmacists to be strategically incorporated into shifting deliver modalities, reimbursement structures, and patient engagement approaches. The authors of this paper, who are public health and health policy experts, propose a comprehensive new primary care typology, emphasizing stratification across delivery mechanism and system roles as opposed to, strictly speaking, provider type or other more traditional definitions. However, while they allude to a broad range of care systems and the growing prevalence of care teams or other novel hierarchies, they do not explicitly address the role of pharmacy in primary care.
The NEJM authors first define care deliverers and care enablers as their primary categories. These are further characterized based on their scope and type of delivery model, such as comprehensive or limited, and targeted to or more inclusive of various patient populations. They then conduct a broad scan of the marketplace to identify currently active organizations, and describe them based on their identity within the rubric established. First noting that primary care has long been framed by “the 4Cs of first-contact care that is continuous, comprehensive, and coordinated,” innovative energies driven by patients, payers, policymakers, and private equity, among others, are increasingly shifting healthcare utilization patterns.
In assessing the potential strengths, weakness, opportunities and threats of a system that embraces these emerging disruptions to practice and payments, it is important to be aware of the various stakeholders, their expectations, and external influencers. For example, consider the threat of a diminishing primary care physician workforce. While the availability of currently practicing primary care physicians decreases, worsened by accelerating retirements and pandemic-related burnout as well as a lack of newly graduating physicians pursuing primary care, there are ample conversations about how best to ensure ongoing accessibility within the system.
This is a dialogue with broad implications around health equity, health technology, and volume- versus value-based care. To compensate, we at Health in Motion Network (HIMN) are not alone in promoting the opportunity of care teams that adequately connect the various providers invested in a patient’s care. Bear in mind, as the NEJM authors write, “The median number of specialists that already-busy PCPs need to coordinate with just for their Medicare patients doubled over the past 2 decades to 95.” If an individual patient has many potential prescribers overseeing their complex, chronic care, with their physical wellness further influenced by mental health and social determinants of health, imagine the strength of a collaborative process that aggregates patient health information through multidirectional communication tools, and empowers pharmacists to work longitudinally with patients to manage their care experience in concert with primary care and specialty physicians, mental and behavioral health providers, and others.
There are acknowledged weaknesses within U.S. healthcare, which can potentially be cured through the adoption of innovative care delivery systems. Among them, the lack of cohesion among provider types. Also, structural obstacles, which could be anything from a high insurance deductible to residence in a medically underserved region, permit or even worsen health inequities. What is unknown, of course, is precisely how new technologies, workflows, payment structures, and other solutions will ultimately alleviate these issues, and influence patients’ and providers’ day-to-day primary care experiences. Not in dispute, however, is that the current, traditional model is no longer applicable. To that end, at HIMN, through our Parawell platform, we are eagerly diving into the conversation. More than that, we’re diving in through our actions. Parawell redefines the pharmacy model, placing pharmacists at the heart of the interactive patient-provider experience, facilitating communication, activating engagement, and delivering outcomes.