4 pills of various sizes and types

Off Label Indications: Provocative Thoughts from a Lifetime Pharmacist

January 1, 2021 — David Medvedeff

Written by: David Medvedeff, CEO, Aspen RxHealth

After more than twenty years in pharmacy, I’ve come to realize there aren’t many places to ingest meaningful news, have controversial conversations, and glean critical lessons that will positively affect how we lead our industry at a time when it’s needed most.

Last year, over 5,760,000 blog posts were published on the internet every single day. The internet is saturated with content, but how much of it is relevant? And why are we here?

It’s my hope that within this small corner of the world we can come together, discuss provocative ideas, and provide counterarguments to the plethora of critical pharmacy topics of today. Metaphorically speaking, think of the conversations shared on this platform as an attempt at “off label” thinking – just as the term off-label stands for the use of medications for an unapproved indication or in an unapproved population, dosage, or route of administration. Why just accept the group think?

So here goes nothing…

Not another 2021 prediction

We’ve all seen the articles pop up in our news and social media feeds; “where will pharmacy go in 2021”, “here are the top 5 trends to watch for in health tech in 2021”, yada yada (yes, my first of likely many Seinfeld Easter eggs).

I’m not here to toss a few more predictions over the fence, I simply want to introduce concepts likely controversial in nature and foster an environment for collaboration and communication.

What better way to break in the blog than to tackle a topic cascading across the decades: Provider Status vis-à-vis Team-based care

The lifelong pursuit of pharmacist provider status. Has the window of opportunity passed us by?

This is going to date me, but I think it’s worth noting that more than two decades ago, I graduated school as an eager and green pharmacist going to work with my Motorola flip phone and MapQuest directions in hand. Pharmacists servicing patients under provider status was a hot topic then and much to my surprise, remains today.

Have we seen adoption and a pivot towards achieving this elusive “provider status?”

Funny how many things change, yet so many stay the same.

Much of the mainstream buzz and excitement about provider status has been backed by the notion that pharmacists will directly bill for their services. With over 4 billion prescriptions dispensed per year, I venture to guess that if every pharmacist billed for every patient interaction, we would singlehandedly bankrupt the healthcare system faster than any other provider.

After twenty years of sitting on the sidelines and observing the innovation invested in healthcare payment reforms, I’d like to think our industry could bring forth new models by now.

Should I still get excited about provider status?

Always thirsty for knowledge, I’ve read countless articles and had numerous conversations which all suggest team-based care is the gold standard for optimal delivery. This makes me wonder – if this is true, what are the rules of engagement for each member of the team? I take this to mean that every player stays close to their core competency and maintains a laser focus on what they are trained to do.

As pharmacists, our role is clearly defined: evaluate current medication regimens, recommend the prescribing or deprescribing of therapies, and monitor/fine tune treatment (based on outcomes) over time.

Pharmacy is a profession with an emotional calling. Providing services to patients who need us most. Polypharmacy patients, those with co-morbidities, and those with complex health conditions will likely benefit the most from our services – and these are the same patient populations who will benefit most from emerging delivery models and team-based care.

So as a healthcare leader, where do I invest time, energy, and business models to facilitate the role of the pharmacist? Do I invest in the emerging models of tomorrow (i.e. care teams) or do I focus these finite resources on a fee for service model that so many other stakeholders are trying to evolve away from?

Emerging models challenging the status quo

There has been an insurgence of healthcare companies in the last few years doing things not done before. Landmark Health is extending care to the patient’s home and as a result, positively monitoring and in some cases eradicating chronic care throughout the country. CareCentrix, another health-at-home solution, is currently managing care for over 26 million members through the use of analytics and insights to reduce unnecessary admissions and reduce gaps in care. Signify Health is another platform supporting the shift towards value-based care. With their technology and nationwide provider networks, I appreciate their disruptive approach to how care is delivered.

When companies are squarely focused on addressing the holistic patient – their clinical, social, and behavioral challenges – we can truly move the needle in improving lives. With all the impressive work being done by organizations like those above (and I suspect many more), I know their need for pharmacists providing true patient care as part of the team will only continue to grow.

We can be part of the problem – more fee for service billing with some short-term financial benefits – or we can aggressively pursue novel models of care leveraging the unique and incredibly important skill-set of pharmacists. In nearly all of conversations with team-based care organizations, I am told what a challenge medication management is. Their desire for a solution is palpable and the prerequisite of provider status is nonexistent in our conversations.

The role of pharmacists must change. Across the board folks are seeing – and believing – in the increased recognition pharmacists receive when they act as integral members of a coordinated care team. And the ability for clinical pharmacists to improve costs and dramatically improve quality measures and health outcomes is here.

Regarding shifting models of care as they relate to pharmacy practice, are you feeling anxious? Excited? We want to hear from you. And of all the hot topic pharmacy predictions you have seen thus far, which keep you up at night? Which give you hope?

Let’s continue the conversation.

Feel free to leave a comment or find us on LinkedIn.

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