Pharmacy is at the table

Today I participated in an invitational roundtable discussion on clinical leadership in health care reform at the Brookings Institution, a leading think tank in Washington, DC. The other invitees were primarily physicians from 12 leading physician organizations, as well as nurse practitioners and nurses.

I shared with the group that, while the number of pharmacists in the US is only about one-quarter that of physicians and about one-tenth that of nurses, most Americans are in a pharmacy several times a month and have ready access to us. While we are in an uncomfortable place between building service offerings (medication therapy management) and finding payment for those services, we have a medication use crisis and there are very few incentives to fix that crisis, despite pharmacists being readily accessible and well trained. Also, we typically make a significant number of referrals to our medical colleagues in the course of our practice.

I further shared that I’ve been encouraging pharmacists to “walk across the street” and talk with physician colleagues about their approach to accountable care organizations and medical homes or medical neighborhoods. We should consider organizing joint listening sessions to learn more, and then to discuss in an interdisciplinary way the best approaches to integrated care delivery. It will only change if it changes at the practice level. I also shared that we have a growing workforce, well trained to integrate with physicians in medication management, but that we need help and cooperation among our physician colleagues to build the business models.

We MUST agree on principles for collaborative practice if we are going to avoid the typical turf wars that occur in state houses around the country when one discipline or another wants to change a practice act. And we must create incentives for all. I shared that incentives are not just about driving selfish action, but are primarily about a system describing through incentives the behaviors and outcomes desired.

I shared, too, how the lack of provider status was not only hurting our profession, but also the medical profession and health care in general. If we pursue it, we will face a major war absent up-front agreement in principle, but all have much to gain, as many of the services we provide will likely be done through physician practices and will lead to gains in improved patient care.

We had a chance to discuss each of these points, and I felt there was agreement that all of these topics were worth continued dialogue. I did not hear any disagreement. While there’s no cause for celebration just yet, I think it’s fair to say that pharmacy is at the table.

Thought you’d like to know.