| by Cheryl Clarke |
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While examining the origins of the Iowa Medicaid Pharmaceutical Case Management (PCM) in a previous article, I encouraged pharmacists to view patient care opportunities such as the PCM program with optimism. As with all opportunities, the potential exists for success or failure, but without the opportunity, not even success is possible.
For readers who are not familiar with the PCM model of care, the PCM model was developed as part of the Iowa Medicaid program to improve medication use by facilitating cooperation between pharmacists and physicians. Patients are eligible for PCM services based on their use of multiple medications and the presence of specific disease states that indicate they may be at high risk for drug therapy problems.
The PCM process of care begins with the pharmacist scheduling a face-to-face visit with an eligible patient for an initial assessment. During this assessment, the pharmacist conducts a complete medication history and pertinent medical history. The pharmacist assesses for the attainment of treatment goals and the presence of drug therapy problems. Patient-specific education and self-management training are provided. Upon completion of these and other specified activities, the pharmacist creates an action plan for the patient’s care and communicates this plan to the treating physician. The physician reviews, then accepts or modifies, the action plan. The action plan is then implemented by the appropriate care team member.
Importantly, this is not the end of the patient interaction – it is only the beginning. A critical component of this program is the longitudinal preventative care provided by the pharmacist rather than episodic care provided as a reaction to a problem. Each assessment includes the establishment of a monitoring plan and a schedule for ongoing assessments. The continuum of care is ongoing through follow-up pharmacist assessments and subsequent communication between the pharmacist and the physician. Along with routine monitoring assessments, additional assessments are performed as new drug therapy problems are identified and require resolution.
The PCM process of care enables pharmacists to improve medication therapy by providing a structure for the care process as well as reimbursement for the care provided by the team. This process has been implemented in the Iowa Medicaid program since 2000. Missouri Medicaid implemented the core components of the PCM program in 2002 under a different program name. Plans are currently underway to implement the PCM model of care in cooperation with the Iowa Farm Bureau Federation and Wellmark Blue Cross and Blue Shield of Iowa.
PCM is one model of care that utilizes the pharmacist’s expertise to improve medication use. PCM is not the only model seeking to improve medication use and, like all models, it has positive and negative aspects. One positive aspect is that PCM is not a proprietary model and can be utilized by any practitioner group, health plan, Medicaid program, Medicare PDP or MA-PD, or any other interested party to fit their needs and goals. Evolution of the model is expected as processes are refined and technology advances communication between the care team.
Just as the pharmacist assessment in the PCM program ends with an action plan, it is time to write your own action plan for patient care. If you practice in an area where the PCM model is implemented, consider enrolling as a provider. If you are a PCM provider, expand your services to more patients or critically examine your current processes to increase efficiencies and productivity. Regardless of your practice site, what existing patient care programs can you access to improve patient care and increase your revenues? What models of care exist to learn from their successes and shortfalls? Who could you approach to implement a new model of care in your area? Your patients, physicians, area employers, state programs, health plan administrators, insurance brokers, health care advocacy coalitions……the opportunities are endless. Develop your action plan today! |
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