(Management Case Study) Outcomes of a Pharmacist-Led Comprehensive Medication Review Program Within an Integrated Care Delivery Network

Purpose: Prior to 2022, Geisinger Health Plan (GHP) contracted with an outside vendor for comprehensive medication reviews (CMRs) for qualifying patients in the health plan’s Medicare Part D option. Starting 2022, GHP internalized the process to utilize Geisinger’s health system-employed pharmacists to contact CMR-eligible members. Members with a Geisinger primary care provider were contacted by ambulatory care pharmacists. Pharmacists in Geisinger’s clinical enterprise work with physicians under collaborative practice. This evaluation quantified the activities of a subset of pateints who saw ambulatory care pharmacists for a CMR.

Methods: A list of patients with Geisinger primary care providers and eligible for CMR was generated quarterly by GHP. We attempted to evaluate 450 patients based on an estimation of 10% of total patients who would complete a CMR with an ambulatory pharmacist. Patients were then placed in one of three groups based on a patient’s relationship with Geisinger’s Medication Therapy Disease Management (MTDM) pharmacy team: current MTDM (i.e., established with MTDM on date of CMR), new MTDM (i.e., referred to MTDM on/following date of CMR), and non-MTDM (i.e., not followed by MTDM). All outcomes were indexed at completion of CMR and reassessed at the end of calendar year 2022. In addition to overall CMR completion rate for the health plan, outcomes analyzed in this study included average change in unresolved care gaps (e.g. overdue vaccines, laboratory monitoring recommendations, routine screenings for patients with diabetes mellitus, etc.), number and type of identified medication therapy problems, acceptance rate of pharmacist recommendations, number of patients converted to Geisinger’s mail order pharmacy, and number of referrals to the ambulatory clinical pharmacist team for chronic disease monitoring.

Results: Ambulatory care pharmacists completed 4,413 of the 4,603 CMRs assigned (95.9%). A subset of 386 patient records were used in the analysis, with 150, 86, and 150 patients in the current MTDM, new MTDM, and non-MTDM groups, respectively. The new MTDM group included 86 patients who were newly referred to clinical pharmacist care upon or following their CMR. Overall, we saw an average reduction in open care gaps of 1.4 following CMR completion (1.2 current MTDM, 1.7 new MTDM, and 1.5 non-MTDM). Medication Therapy Problems (MTPs) were resolved for 76% of patients overall (132/174), with the highest percent of MTPs resolved in patients in the new MTDM group (86%; 30/35) and similar MTP resolution rates in the Current MTDM (73%, 52/71) and non-MTDM (74%, 50/68) groups. Pharmacists were able to independently resolve 84 MTPs; 90 MTPs required provider and/or patient consultation and 48 of those were ultimately successful resolutions. We saw a mail order prescription capture rate increase from 40.9% to 48.7%, with both MTDM-associated groups enrolling a larger percentage than the non-MTDM group.

Conclusion: The use of health-system employed pharmacists who have a practice relationship with primary care physicians to complete CMRs created opportunities for pharmacists to be involved in the acute management of medication therapy problems and longitudinal management of chronic conditions for patients. The pharmacist-physician relationship in a health system yielded high drug therapy recommendation acceptance and referrals to other pharmacy services within the health system.