A study funded by the Center for Medicare and Medicaid Innovation (CMMI) http://innovation.cms.gov was posted on September 16, 2015 on the http://innovations.ahrq.gov web site involving the University of Southern California, School of Pharmacy http://pharmacyschool,.usc.edu and AltaMed Health Services www.altamed.org.
AltaMed Health is the largest independent FQHC in the U.S, delivering more than 930.000 annual patient visits through its 43 sites in Los Angeles and Orange Counties. The university and AltaMed are partnering to enable pharmacy teams to provide medication management services to at-risk underserved patients via video consultations.
Teams taking responsibility for the patient’s medication-related outcomes have identified medication-related problems and are able to provide education and changes to medications and dosages as appropriate.
Uninsured individuals in low income areas very often rely on safety net clinics, where physicians and staff have little or no time to help patients understand and adhere to their medication regimens. Adherence is particularly low for complex regimens and in addition, many patients with chronic diseases initially adhere to their regimens, but stop taking their medications after a few months since many need help in understanding the medications and how important they may be.
In 2011, USC and AltaMed jointly secured a Health Care Innovation award from CMMI. The $12 million three year grant called for the use of pharmacy teams made up of pharmacists, pharmacy residents, and pharmacy technicians to work with at-risk patients.
The plan called for onsite teams at ten clinics during the first two years, followed by implementation in year three of the telepharmacy approach through an 11th team serving two low-volume sites.
When the initial grant period ended June 30, 2015, program leaders received a no-cost nine month extension so they could spend the remaining funds. Based on the success of the video approach, they decided to transition all of the clinics to telepharmacy, adopted, and implemented a new low cost IT platform in each clinic.
Once the no-cost extension ends, USC plans to continue offering the program via video link and by phone to health plans and other public and private payers in California. USC program leaders are working with the California Department of Public Health www.cdph.ca.gov to offer the program throughout the state. AltaMed is trying to determine whether the program can still be offered once grant funding ends and if so, what form it will take.
Going forward, AltaMed hopes to secure at-risk contracts that will provide financial rewards for reducing the use of acute care services. It is most likely that the telepharmacy program will continue in a limited form with an offsite pharmacist supported by mid-level providers in some clinics.
In general, the program has improved chronic disease outcomes, reduced emergency department visits and hospitalizations, and has generated significant cost savings along with high levels of satisfaction among both patients and physicians. While most of the evidence comes from patients served by the onsite program used in ten AltaMed clinics, the telepharmacy approach has be found to equally effective in two smaller clinics.