ACCP, in collaboration with member pharmacy organizations of the Leadership for Medication Management (LMM) coalition, has actively engaged the Patient-Centered Primary Care Collaborative (www.PCPCC.net) in discussions during the past few weeks to promote the inclusion of pharmacists’ clinical services within the “medical home” framework for national health care reform. Key stakeholders in PCPCC include the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association. ACCP has joined PCPCC as a stakeholder organization and will participate in the April 28, 2009, Stakeholders Working Group meeting in Washington, DC.

Seven principles for the inclusion of pharmacists’ clinical services in the patient-centered primary care medical home have been developed and shared with PCPCC, U.S. Senate committees with jurisdiction over Medicare and health care reform issues, and others involved in reform at both the national and state levels. Those principles are:

• Access to pharmacists’ clinical services: provision of pharmacists’ clinical services should be a fundamental component of the patient-centered primary care medical home;
• Patient-focused collaborative care: development, implementation, and monitoring of medication treatment plans, including an effective system for medication reconciliation that supports patients in their transitions among care settings, should be accomplished through a patient-focused, collaborative process of clinical consultation and decision-making that incorporates the synergistic and complementary knowledge and skills of the prescribing professional(s) and pharmacists within the medical home practice;
• Flexibility in medical home design: innovative and flexible practice structures that integrate pharmacists’ clinical services should be encouraged to meet the needs of individual patients who are cared for within the medical home. Incorporation of pharmacists and their services either by their physical presence within the practice or through the design of effective “community linkages” should be considered to meet geographic and practice setting needs and variations;
• Development of outcome measures: objective measures for assessing the clinical outcomes, safety, and cost-effectiveness of medication use in the population being served by the patient-centered medical home must be a component of the practice’s broader quality performance measurement system;
• Access to relevant patient information: all members of the medical home patient care team, including pharmacists, must have access to necessary and appropriate patient health and medical records to support and inform their clinical service and decision-making functions. This access must also include the authority and responsibility to directly input information into these records to facilitate enhanced team-based knowledge and information support for the respective clinical and decision-making responsibilities of team members;
• Effective health information technology: expansion and effective use of health information technology must be promoted to support more complete integration of pharmacists as care providers within the medical home practice structure;
• Aligned payment policies: payment policies should be aligned to (1) effectively support the medical home, (2) provide reasonable and adequate payment for pharmacists’ clinical services as an element of the scope of services that are eligible for payment to either the providers or the practice, and (3) promote the achievement of higher-quality, safer, and more effective therapeutic outcomes from medication use through enhanced provider collaboration.

The full principles document, including background information and a list of supporting pharmacy organizations, can be found at http://www.accp.com/docs/misc/pcmh_services.pdf.

Support for these principles has been demonstrated by PCPCC leadership through the establishment earlier this month of a working group to develop an expanded document incorporating the principles with a description of operational and payment methodology models for consideration by the PCPCC executive committee within the next several weeks.

A recent call to ACCP members of the Ambulatory Care and Adult Medicine PRNs for information and examples of integrated interprofessional practices yielded a great deal of very helpful information that has supported this effort very effectively. All ACCP members are encouraged to review the principles and share thoughts and insights with the ACCP government affairs staff to assist the College as these discussions proceed. If possible, encourage your physician colleagues who are members of stakeholder medical organizations of the PCPCC, and who value and use your services within their practice, to communicate their support for the inclusion of pharmacists’ clinical services in the medical home model to these organizations.

Health Care Reform—Many Opportunities for Impact

As the larger health care reform debate continues this spring and summer, ACCP members are encouraged to be active at the state and local levels as well in advocating for improving the safety, outcomes, and cost-effectiveness of medication use through the services you provide. You should take advantage of the following types of opportunities and initiatives during the next several weeks:

• Visit www.healthreform.gov and share your perspectives and insights on health care reform generally and the improved medication use quality, safety, and outcomes that result from your services to patients. Even more importantly, make your patients aware of this Web site and encourage them to share their perspectives as well—especially if they have personal stories to tell about how your services and care have benefited them. Health care reform leaders in government and the private sector are actively monitoring this Web site for information, ideas, and priorities.
• Contact local offices of your congressional delegation this spring and summer, especially during recess periods, to make appointments to visit them or to invite them to visit your practice to see firsthand your direct patient care role. Contact the ACCP Government Affairs office for information on recess schedules and resources to assist you in these efforts.
• Participate in local and state-level discussions on health care reform, taking every opportunity to advocate for improved medication use quality, safety, and outcomes through the provision of pharmacists’ clinical services.

The opportunity for substantial health care reform at all levels—national, state, and local—has rarely been more promising than it is now, despite the economic challenges the country currently faces. When the history of the effort to reform the U.S. health care system in 2009–2010 is eventually written, will you be able to say you did your very best to help make it happen this time?