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Chronic care management (CCM) aims to improve health outcomes by enhancing care coordination for patients with multiple chronic conditions. However, few incentives have been provided in recent years for health care professionals to engage in models that improve care coordination. These potential models could help avoid poor health outcomes that lead to hospitalizations and rehospitalizations. Fortunately, in January 2015, under Medicare's physician fee schedule, Medicare began paying separately for CCM services. Qualified health care providers are reimbursed for these coordination of care services. Though pharmacists cannot bill Medicare for these services, they are in a prime position to deliver CCM services and be paid by forming contractual and collaborative partnerships with qualified providers. CCM bridges the gap between fee-for-service and value-based payment models by focusing on care coordination among health care providers.

As community-based pharmacy continues to evolve from a focus on product distribution to a practice focused on patient care, a key requirement is for pharmacists to document their patient care activities. Some community-based pharmacies are working to routinely use the Pharmacist eCare Plan standard in documenting their new care activities. With the need for a robust patient record in community-based pharmacies, the purpose of this study was to identify key elements and functionalities for a community-based pharmacy patient record. An expert panel of 26 individuals participated in 3 rounds of surveys using an online Delphi method to develop consensus about the key data elements and functionalities for a pharmacy patient record system. A total of 46 items reached consensus: 16 as essential elements for a longitudinal pharmacy patient record, 7 as essential elements for a patient encounter, and 23 functionalities for a pharmacy patient record system. A rubric was developed to assess community-based pharmacy patient record systems. The functionalities can support pharmacists in fully adopting a standard care process and providing and documenting patient care, while coordinating and improving communication with patients, providers, and payers. Pharmacists are encouraged to use the rubric in evaluating software for their practices. [ABSTRACT FROM AUTHOR]

Background: Pharmacists in community-based settings document patient care using the Pharmacist eCare Plan (PeCP).Objective: To conduct a pilot evaluation of the PeCP use and documentation of Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes within select community-based pharmacies.Practice Description: Moose Pharmacy operates 7 locations in rural North Carolina that are part of the Community Pharmacy Enhanced Services Network (CPESN). The Moose Pharmacy Medication Adherence Program (MooseMAP) targets patients with a chronic condition who would benefit from medication synchronization, adherence packaging, and monthly calls.Practice Innovation: CPESN pharmacies use the PeCP to track a patient's concerns, goals, interventions, and medication-related information. The PeCP standard requires pharmacies to detail a patient's current medication regimen and health concerns as well as the pharmacy's interventions and patient's health over time.Evaluation Methods: Data were included if the patient was enrolled in MooseMAP and had a free-text note in the eCare Plan. Data were excluded if the medication-related problem (MRP) or intervention was a general health problem without a valid SNOMED CT code. Data were categorized into MRPs, medication interventions, education, and referrals. The International SNOMED CT browser and pharmacy health information technology (PHIT) value sets were searched; data sets without existing codes were submitted to the appropriate oversight authorities for future inclusion. Data were analyzed using descriptive statistics.Results: Emerging codes were identified that resulted in 91 recommendations to PHIT for development of new SNOMED CT codes and 113 recommendations to PHIT for inclusion in the PHIT value sets. In total, 66% of MRPs did not have a valid SNOMED CT code, and 78% of MRPs were not included in a PHIT value set. The most prevalent gap in MRP or intervention documentation related to medication use issues.Conclusion: Incorporating emerging codes into documentation systems should enable the profession to better communicate value to health care stakeholders. [ABSTRACT FROM AUTHOR]

Purpose Health‐system pharmacists and community‐based pharmacists have long held professional relationships. However, the success of each group is often not interdependent and aligned. In 2018, the American College of Clinical Pharmacy (ACCP), CPESN USA, and the National Community Pharmacists Association (NCPA) Innovation Center led a meeting to build patient‐centered pharmacist teams to achieve medication optimization across care settings. Seven community pharmacists and health‐system/clinic‐based pharmacist teams participated in this meeting and left with the intentional commitment to build sustainable partnerships. This report describes the establishment of this partnership, and the subsequent application of Guiding Statements for these collaborations. This report also describes both the successes realized and the lessons learned, and to serve as practical recommendations for institutions interested in pursuing similar partnerships. Results: Initial learnings from these partnerships have provided a proof of concept that an intentional approach to the relationship between a health‐system/clinic‐based pharmacist and community‐based pharmacist can lead to improvements in patient care as well as a professional collaboration. We experienced improved communication and closed‐loop care, improved professional relationships across care settings, and enhanced clinical services. However, these partnerships were not without challenges. For instance, lack of interoperability and limited electronic health record access made certain outcomes difficult to track. Conclusion: The purposeful establishment of partnerships between health‐system/clinic‐based pharmacists and community‐based pharmacists, built upon the needs of both entities, allowed institutions to develop an aligned commitment to care for shared patients. Over the initial years of these partnerships, many successes were realized and lessons were learned. Both the successes and the challenges can serve as beneficial resources for institutions interested in developing similar partnerships. [ABSTRACT FROM AUTHOR]

Objectives: To determine the financial impact of attributed patients enrolled in a medication adherence program at Community Pharmacy Enhanced Services Network (CPESN) pharmacies.Setting: Five independently owned Moose Pharmacy locations in rural North Carolina, which are CPESN pharmacies.Practice Description: Moose Pharmacy has a longstanding history of innovative change. Each Moose Pharmacy location provides enhanced pharmacy services, including adherence packaging, medication synchronization programs, immunizations, home visits, home delivery, comprehensive medication review, disease state management programs, point-of-care testing, and compounding.Practice Innovation: Certain CPESN pharmacies, including Moose Pharmacy, were attributed complex Medicare or Medicaid patients having at least 1 chronic medication and at least 80% of medications filled at a CPESN pharmacy. Patients were included if they were attributed to a study location and enrolled in the Moose Medication Adherence Program (MooseMAP) for more than 12 months. Patients were excluded if they were younger than 18 years of age or had less than 12 months of prescription fill data. Reviewed data included patient demographics, chronic and acute medications, immunizations, MooseMAP type, number of chronic medication prescribers, chronic medication class, payer, and patient health risk indicators. Yearly profit for prescriptions filled was determined per patient. Independent-samples t test was used to assess data.Evaluation: Yearly profit per prescription was $10.35 for combined chronic, acute, and immunization prescriptions, $10.57 for chronic prescriptions, $26.95 for acute prescriptions, and $27.69 for immunizations. Mean profit for strip packaging was $1561.82 per year compared with $1208.01 per year with bottles (P = 0.021). There was a positive correlation between profit and number of prescriptions filled per 12 months (r = 0.56; P < 0.001), number of medication classes (r = 0.27; P < 0.001), and higher-risk indicator scores (r = 0.21; P < 0.001).Conclusion: Enrolling complex patients in a medication adherence program can benefit community pharmacies, particularly CPESN pharmacies, through chronic medication fills and yearly profit. Greater profit is generated when prescriptions are dispensed in strip packaging instead of bottles. [ABSTRACT FROM AUTHOR]