Future Trends: Integration, chronic care lie ahead for pharmacy

What will retail pharmacy look like in 2027? Predicting the future is always iffy, but it’s certain that it will involve a lot of “C” words. Among them are connectivity; computing or, more accurately, the use of supercomputers in advanced diagnosis, medication therapy and drug development; collaboration; clinical care; and cost-saving imperatives.

All of those pursuits will involve the increasing use and sharing of electronic health records, or EHRs, and decision-making data to improve population health and lower the costs of care, and all will figure prominently in any pharmacy practice model that emerges over the next decade.

Looking ahead, Laura Cranston, executive director of the Pharmacy Quality Alliance, said, “I think pharmacy will be fully integrated, clinically, with the rest of the care provider team. And I think all the necessary steps are in motion.”

For pharmacy retailers, one big step toward a more viable and integrated future in partnership with the rest of the healthcare system, Cranston told Drug Store News, has been establishment of the eCare Plan for Pharmacists, written and developed by the Pharmacy Health Information Technology Collaborative. The plan, she said, is a template for linking pharmacists more closely with patients’ electronic health records in order to foster closer collaboration between pharmacists and other members of an integrated healthcare team.

“As medicine has moved to EHRs, how does pharmacy get its hands on the clinical data that resides in an EHR, and how do they access and use it? They will through this eCare Plan; it will be fully integrated in EHRs,” Cranston said. “It’s a critical step in the process … of an integrated delivery system.”

Cranston predicted “this high level of clinical integration” will be achieved by pharmacy’s “early adopters over the next 12 to 18 months. Then it will reach a critical mass, and others will begin to use it,” she said.

The eCare initiative will drive pharmacy-based health innovation and connectivity, according to the National Council for Prescription Drug Programs. “Pharmacists are increasingly participating on patient-centered care teams as essential members, providing clinically oriented patient care services,” NCPDP reported. “The Pharmacist eCare Plan will support the documented integration of these activities into the patient’s comprehensive care plan.”

‘Everyone held accountable’

Another ongoing trend that will continue to shape pharmacy’s future, Cranston said, “will be

for pharmacy and pharmacists to be held accountable in a value-based healthcare system. Whatever happens with the Affordable Care Act — repeal, replace or whether Obamacare stands — the notion that we are going to operate inside a value-based system will continue to grow,” Cranston predicted. For that reason, she added, “outcomes-based measures are the next wave of the future. And contractually, health plans, PBMs and other payer entities are driving this move to value-based care.”

Health economist Jane Sarasohn-Kahn agreed. “With the migration from volume-based payment to value, the healthcare provider … is taking on more risk in managing the outcome for their patients on an individual basis, or in terms of population health,” she told DSN.

Given this “migrating moment in healthcare payment,” Sarasohn-Kahn said the pharmacy “has a major opportunity to be the hub or platform in the health ecosystem. They’re in the community. They’re not on ‘pill hill,’ and they’re not in the doctor’s office, which is only open Monday through Friday so many hours a day.”

The challenge that pharmacy must deal with in its quest to remain a fully viable component of the emerging health system is the same one faced by all sectors of the healthcare spectrum, said Sarasohn-Kahn, author of the Health Populi blog. “How do different nodes in the healthcare system work together to create an ecosystem with the patient at the center? I talk about pharmacy playing a big role in that because they’re in the community, and they know the prescription list for the patient, which is a very powerful piece of information,” she noted. “If you know that, you know a lot about the patient.”

Increasingly, retail pharmacies are equipped and positioned in the healthcare marketplace to serve as a base not only for medication-related dispensing and counseling services, but also for a growing menu of other health products and services that support patient health and improved outcomes. In the coming years, they’ll serve as a key connection point and entry into the broader health network. “In this environment, digital health … is growing,” Sarasohn-Kahn said. “Digital therapeutics are a way for pharmacy to add value beyond the pill.”

Shifting from ‘sick care’ to wellness

Despite that hopeful outlook, pharmacy and the rest of the health system are a long way from creating a truly holistic, fully integrated and patient-centered model for cost-effective care. Even though “patient engagement is the lynchpin to any successful value-based care initiative,” said Judy Murphy, chief nursing officer for IBM Global Health, a 2016 study by the company found much of the health system still mired in what Murphy called “a no man’s land,” between the fee-for-service model and the value-based model.

Indeed, Murphy said most healthcare organizations still are operating “in a ‘sick care’ episodic and transactional mindset, whereby the main drivers of patient engagement were brand loyalty, positive patient experience and regulatory compliance, as opposed to a health-and-wellness, continuum-of-care mindset, where the focus is on value.

“This finding represents a challenge because involving patients in their own healthcare decision-making is a critical element in shifting to a value-based model of care,” Murphy noted. “It is the only way to truly deliver a system designed to address the needs of a healthcare population.”

Today, “the health ecosystem is faced with ever-increasing demands and is riddled with obstacles, complexity and siloes,” agreed IBM chairman, president and CEO Ginni Rometty.

Anil Jain, VP and chief medical officer for IBM Watson Health, said all health stakeholders will have to continue knocking down the decision-making silos that stand between the fee-for-service model and the collaborative, outcomes-focused care model.

“Despite progress and a movement toward value-based care, the U.S. healthcare system still tends to struggle with acquiring and analyzing the varied data sets needed to meaningfully improve health care,” Jain said. “In many instances, health data remains siloed and fragmented by hospital boundaries, incompatible vendor systems, interoperability issues and complex regulatory challenges. These hurdles often mean that a complete picture of care across the continuum for a patient or a population is challenging, if not impossible.

“Today, the need for complete patient and population health profiles is growing under the demand of many stakeholders,” Jain added. “One motivating factor is the shift to value-based care, supported by the Centers for Medicare and Medicaid Services’ goal to have half of its payments in alternative payment models by the end of 2018. Another factor is the growing number of accountable care o