The pharmacist has long been the unsung hero in healthcare. I learned this during my time at InterbrandHealth where we worked closely with pharmacists to assess the likelihood that a potential drug name might cause confusion due to look-alike and sound-alike issues. Through that experience, I discovered the extensive clinical knowledge that these professionals possess. They know about every drug under the sun as well as disease states, co-morbidities, and barriers to medication adherence. Yet pharmacists generate few accolades in our current system and their potential for managing patient populations is largely overlooked. That is likely to change under the new pay-for-value paradigm. Much like nurse practitioners have replaced primary care physicians in many patient encounters, pharmacists will be called upon to do far more than dispense drugs. Dr. Patrick Carroll, Chief Medical Officer of Walgreens Healthcare Clinics, confirmed this during a talk he gave at InterbrandHealth on January 14, 2015. He was there to discuss the changing role of the pharmacy in the healthcare delivery system. Today’s pharmacy chains are doing far more than filling prescriptions and selling shampoo – they are delivering flu shots, treating colds, counseling patients and more. In certain respects they are taking on the role of primary care provider.
The shift has occurred because the old locus of operations is disappearing. In the good, old (i.e. unabated fee-for-service) days, you visited your doctor's office when you felt sick or needed a shot, but today there is a primary care shortage. Dr. Carroll spent nearly three decades as a practicing PCP managing some of the most difficult-to-treat patient populations. “Being a PCP is the most difficult job in the world,” he professed and proceeded to share study findings that supported his point - one being that between 30% and 50% of current primary care practitioners plans to leave practice within the next 10 years. As he pointed out, “The ACA has added all of these patients with insurance, but good luck finding a doctor.”
That holds true at Walgreens, too. A $130 billion company, Walgreens employs only four physicians. Pharmacists are the go-to clinical providers and are expected to be “not just dispensers but counselors.” This makes sense. Pharmacists are armed with extensive knowledge of the most prevalent conditions (e.g. diabetes, asthma, CHF, depression) and know more about medication management than any other healthcare provider. They have the time to provide high quality, high touch visits that doctors simply can’t or won’t, and they have access to patients. Dr. Carroll pointed out that a typical patient with diabetes might see her doctor two to four times a year. That same person will visit the pharmacy 20 to 30 times in the same year providing many more touch points.
The results can have dramatic health and financial implications. Fifty percent of patients with type 2 diabetes do not take their medications as prescribed resulting in a cost of nearly $9,000 annually per individual for non-compliance. Imagine the impact a trusted pharmacist could have on these numbers.
Dr. Carroll proclaimed, “For years we have ignored the consumer, we can’t do that anymore.” I would add: For years we have ignored the pharmacist, we can’t do that anymore either.