Affordable Care Act and Pharmacy: Big Changes Ahead?
The ACA provides for grants or contracts with interdisciplinary teams (including pharmacists) which support primary care providers. Patient-centered medical homes include:
• A primary care provider;
• A whole-person orientation;
• Coordinated and integrated care;
• Safe and high-quality care;
• Expanded access to care; and
• Payment that recognizes the added value of patient-centered care.
These teams must provide support for primary care providers who provide patient access to pharmacist-delivered MTM services -- such as chronic disease management, preventative services, and health promotion. For example, patients discharged from hospitalization to a less intense standard of care need postdischarge medication management.
The ACA also allows state Medicaid programs, which include pharmacists, to assist individuals with chronic conditions (see Section 2703). Accountable Care Organizations may also receive payments in the form of shared savings for managing Medicare beneficiary care. These payments would be in addition to those already allowed under traditional fee-for-service Medicare Parts A and B.
These examples represent the primary opportunities for pharmacists. There are other sections that may also include pharmacy services, such as the Center for Medicare & Medicaid Innovation within CMS (Section 3021), testing of payments and incentives to use home-based primary care teams (independence at home, Section 3024), medication reconciliation activities (transitions of care, Sections 3025 and 3026), and reduction of healthcare-acquired conditions (Sections 2702 and 3008). Which of these programs will turn out to be successful in long-term revisions of the healthcare system remains to be seen.
Pharmacist Role in Integrated Care Models (Sections 3502 and 10321)
The ACA provides for grants or contracts with interdisciplinary teams (including pharmacists) which support primary care providers. Patient-centered medical homes include:
• A primary care provider;
• A whole-person orientation;
• Coordinated and integrated care;
• Safe and high-quality care;
• Expanded access to care; and
• Payment that recognizes the added value of patient-centered care.
These teams must provide support for primary care providers who provide patient access to pharmacist-delivered MTM services -- such as chronic disease management, preventative services, and health promotion. For example, patients discharged from hospitalization to a less intense standard of care need postdischarge medication management.
The ACA also allows state Medicaid programs, which include pharmacists, to assist individuals with chronic conditions (see Section 2703). Accountable Care Organizations may also receive payments in the form of shared savings for managing Medicare beneficiary care. These payments would be in addition to those already allowed under traditional fee-for-service Medicare Parts A and B.
These examples represent the primary opportunities for pharmacists. There are other sections that may also include pharmacy services, such as the Center for Medicare & Medicaid Innovation within CMS (Section 3021), testing of payments and incentives to use home-based primary care teams (independence at home, Section 3024), medication reconciliation activities (transitions of care, Sections 3025 and 3026), and reduction of healthcare-acquired conditions (Sections 2702 and 3008). Which of these programs will turn out to be successful in long-term revisions of the healthcare system remains to be seen.