The Annual Wellness Visit's Unsung Superhero: The Pharmacist 

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The Annual Wellness Visit's Unsung Superhero: The Pharmacist 
by Amanda Martin

When you think of a pharmacist, you probably visualize the person in the lab coat behind the counter at your local pharmacy. Pharmacists are always there, ready to fill our prescriptions with precision, accuracy, and counsel us on adhering to our prescribed medication therapies. But could a pharmacist also be the Medicare annual wellness visit's (AWV's) — and the time-strapped provider's — superhero incognito?

A new healthcare delivery model is emerging, and practice administrators and providers are taking note on the value of incorporating a pharmacist into their practice care team. Pharmacists are highly trained clinicians. To become a pharmacist, one must undertake eight years of schooling, spending at least a few of those years studying medications, participating in specialized residencies, and partaking in rotations in clinical and pharmaceutical settings.

After all that training and schooling, pharmacists are clinical doctors, specifically holding the Doctor of Pharmacy degree, PharmD. Since pharmacists are clinical doctors, why not integrate them into the primary care team and take advantage of their extensive knowledge and expertise? With the addition of a pharmacist, your practice can enhance the delivery of positive patient outcomes and improve medication and treatment adherence rates, all while reducing the overall cost of delivering good patient care and possibly growing volume in the process.

How Pharmacists Can Improve Patient Care in the Primary Care Setting

Incorporating a pharmacist into the primary care team can help a practice achieve better patient outcomes by developing a comprehensive medication management (CMM) model. Working in conjunction with the entire healthcare team, primary care providers (PCPs) and pharmacists can create a whole-person approach to care, partnering to better serve the patient by not only assessing wellness and disease processes, but also the patient's medications (prescription, over-the-counter, vitamins, herbals, etc.) to ensure therapies are appropriate, safe, and, most importantly, effective.

The scope of a pharmacist's practice is much wider than many people realize. Pharmacists can perform patient assessments, order and interpret medication therapy-related testing, monitor medication use, coordinate patient care for general wellness and the prevention of diseases, provide immunizations, educate patients and caregivers about medications and medication management protocols, update and document in the patient's medical record, and bill insurance for providing cognitive services. Pharmacists can also provide preventive services and participate in chronic care management (CCM) services. 

Annual Wellness Visit Partnership: Good for Your Practice, Good for Your Patients

When working together, PCPs and pharmacists can decrease the frequency in which patients use the healthcare services through broader and enhanced patient engagement. Together, the PCP and pharmacist team can encourage better patient adherence to treatment regimens, thus improving Centers for Medicare Medicaid Services quality measure scores that can preserve or boost reimbursement.

Pharmacists can also provide PCPs with direct access to their specialized medication knowledge. This will help decrease redundancies in care and help fine-tune individual treatment plans. Moreover, pharmacists are often skilled in the navigation of insurance plans and how they cover patient medications. Most importantly, pharmacists, as allied healthcare professionals (AHPs) identified by Medicare, can perform annual wellness visits, thus freeing up provider time to focus on more acute patient issues. 

According to Medicare, nonphysician AHPs, such as pharmacists, may perform AWVs if they are working under the order and supervision of a physician. Additionally, the Centers for Disease Control and Prevention (CDC) recently identified pharmacists as an optimal choice among AHPs to perform the AWV. 

In support of taking such an approach to performing the AWV, a 2017 North Carolina Medical Journal article highlighted a study that evaluated the effectiveness and financial benefit of a pharmacist performing AWVs on more than 50 eligible Medicare beneficiaries. The study found that the pharmacist identified nearly 300 medication-related problems. Among these problems: patients weren't using the best medication for their condition, medication therapies weren't being properly monitored, and chronic conditions were not being treated with the attention they should. By having a pharmacist conduct these AWVs, the reimbursements generated offset and even exceeded the cost of the pharmacist's time. 

Integrating a pharmacist into the PCP setting to perform AWVs for your Medicare beneficiaries could be very valuable to your practice, saving providers time while increasing reimbursement opportunities. One important note: Pharmacists integration is not likely to be as simple as "plug and play." Rather, as a Pharmacy Practice article notes, fully realizing the value of adding pharmacists to the team to conduct annual wellness visits will require ongoing emphasis on interprofessional training. "There is a need to ensure that pharmacist education embraces principles of geriatric assessment, clinical prevention, and advance care planning in order to fully prepare pharmacists to complete all AWV elements. Additionally, educators should ensure that pharmacists obtain the practice management skills necessary to develop models that support the AWV." 

Proceeding With the Annual Wellness Visit Partnership

AWVs are an important part of any practice that cares for Medicare beneficiaries, but they can be difficult and time consuming to integrate into a practice schedule. Exploring this new care delivery model might provide your practice with the opportunity for PCPs and pharmacists to team up and form a valuable partnership. Finding ways that your practice could integrate a pharmacist into its care delivery team will be unique to your practice's situation and specific needs. Determining the most cost-effective way of integration will be a key component of a successful partnership. 

One way to achieve a pharmacist-PCP partnership could be to hire a pharmacist. Another popular way to integrate a pharmacist into your care team might be through a collaborative practice agreement (CPA) that would allow a pharmacist to come into your practice on a contract basis to perform AWVs. CDC defines a pharmacist CPA as, "A formal agreement in which a licensed provider makes a diagnosis, supervises patient care, and refers patients to a pharmacist under a protocol that allows the pharmacist to perform specific patient care functions." The rules governing CPAs tend to vary greatly by state, with some states even using alternative terms to CPA, such as "collaborative pharmacy practice agreement," "collaborative care agreement," or "collaborative drug therapy management." Learn your state's CPA rules before proceeding with a partnership. 

Ultimately, deciding on whether integrating a pharmacist into your team is a feasible option should be an independent decision based upon your practice's specific needs. Nevertheless, considering this new care model could be beneficial for your providers, your patients, and your bottom line, it definitely deserves a closer look. 

Additional sources:

Medicare Annual Wellness Visits On-Demand

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