About three years ago it became clear to the leadership team at RWJBarnabas Health that pharmacists were needed in its 68 ambulatory clinics.
Its providers—and the system overall—are increasingly participating in value-based contracts with payers that involve metrics related to medication adherence, adverse drug events and other clinical outcomes, which pharmacists can affect by managing patients’ medication therapy.
“When you are looking at managing the health of a patient and you are looking at lowering healthcare utilization dollars, it makes sense to have the pharmacist in the ambulatory space,” said Indu Lew, chief pharmacy officer at RWJBarnabas Health.
So, since August 2017, the 11-hospital, New Jersey-based health system has been slowly building its pharmacy workforce in the outpatient setting, with four pharmacists now splitting time in several clinics where about 45 doctors are based. But Lew said that only scratches the surface of what is needed. There are “hundreds” of doctors who work in RWJBarnabas clinics and more and more are beginning to ask for a pharmacist since they’ve seen the impact they can have on practices, she said.
Despite the urging from doctors, it’s a battle for Lew to justify to the C-suite the pharmacists in use now and to convince them that more should be brought on.
“As with any initiative you are starting you have to prove your worth, you have to prove the impact they (the pharmacists) are making,” Lew said. “We struggle with attaching a dollar value to something that we have avoided that potentially could’ve happened if the pharmacist wasn’t there.”
The challenges experienced by Lew aren’t unique. Other pharmacy executives at health systems say they struggle to increase the pharmacy workforce in outpatient settings because leadership wants to see clear returns on the investment, which is challenging to prove with data. The pressure to show the direct impact a pharmacist makes on costs and outcomes is exacerbated by the fact that their services can’t be reimbursed by Medicare or Medicaid because they aren’t considered healthcare providers under the Social Security Act.
“With pharmacists not being in the Social Security Act, that is a barrier to being able to bill appropriately for those patients,” said Eric Wymore, vice president of pharmacy services for the Pacific Northwest region of CHI Franciscan Health.
There is evidence, however, that the number of pharmacists in ambulatory settings at health systems is rising. According to a recent survey of 811 hospitals from the American Society of Health-System Pharmacists, 32.9% of hospitals had pharmacists in ambulatory clinics in 2018, up from 18.1% in 2010.