Pharmacy data-sharing will enable future of value-based care provision

As we look toward this New Year and at the big picture, pharmacies and providers across the healthcare spectrum continue transitioning care models from fee-for-service to value-based provision. Behind the pharmacy counter, processing the prescriptions accurately and achieving billing compliance have so far been the priority, and rightfully so. But with new demands that focus on treating the entire patient with outcomes in mind, the whole healthcare value chain is involved and at stake.

Pharmacy operations are very much part of successful patient outcomes and as such play a huge role in the clinical care continuum. Consider that the pharmacist remains the most accessible healthcare practitioner for patients, who come frequently and regularly to pick up prescriptions, ask advice about over-the-counter medications or ask general questions about overall health. Payers and pharmacy benefit managers view the pharmacist and pharmacy role as an evolving one that shoulders much more responsibility for outcomes.

According to Prescriptions for a Healthy America,” poor medication adherence results in 33 to 69 percent of medication-related hospital admissions across the U.S., at a cost of roughly $100 billion annually. At least 125,000 Americans die each year due to poor medication adherence.

This burden of adherence and general patient responsibility requires much more transparency in care. Ideally, treating the whole patient requires that all care team members have access to the important information surrounding the patient’s health — test outcomes, family history, laboratory results, and of course, medication history.

Across the entire healthcare system, providers need access to multiple datasets for knowledge sharing and open communication. Pharmacy, unfortunately, is the missing link. When a patient is admitted to a hospital or treated at a specialist, the onus is on him to report current and past medications. What if the patient is unconscious? Confused? Forgetful? Purposefully evasive?

A contributory, linking database in which pharmacists, and other providers, would willingly share important health information would translate to better patient care for the good of the entire industry. While pharmacy chains currently keep patient data within their organizations, companies within the auto insurance industry, for example, freely share claims and accident report data for the good and safety of all drivers. Surely, there are obvious concerns with sharing specific transaction information with competitors but success will be achieved when the industry has meaningful dialogue about these concerns and determines how to overcome them instead of using them as an excuse to put off data sharing efforts.

Finding the right solution for data integration is the gateway to a much-needed inevitability: a unique patient identifier, or UPI, for every single patient. The myriad benefits of a UPI include both patient safety and opioid abuse reduction and prevention. Healthcare ID fraud is a significant problem and, unfortunately, a recent trend. Pharmacies must guarantee that the person who is receiving care — and medication — is the person he says he is. Without the vigilance of a patient management tool to detect fraud on the pharmacy’s end, patients may acquire drugs from several different locations for personal use or even distribution. Across the larger healthcare spectrum, identification fraud may be executed to collect and steal payments. By contributing vital information to a database that implements widespread linking capabilities, pharmacies can reap the benefits of fraud protection while focusing on patient-centered, value-based provision of services.

While mandatory contributory state databases do exist, a broader voluntary application would yield broader results. Certainly, having an industry contributory database configured within the pharmacy’s regular workflow would mean the right data at the right time at the fingertips of pharmacists everywhere, enabling seamless automation for meeting state compliance requirements. True interoperability would enhance the prescription drug monitoring programs, or PDMPs, already in place, and make room for more comprehensive efforts.

Extensive data linking also opens up possibilities for analytics applications that help pharmacists treat patients better. For example, social determinants of health, or SDOH, — conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes, according to the Centers for Disease Control and Prevention, factor into outcomes. Certain socioeconomic information can help predict medication adherence and propensity for addiction. With tools that provide a broader understanding of each patient, pharmacists are presented with quick, actionable decision points that suggest the best way to intervene with the specific patient, increasing adherence and safety.

The next generation of pharmacists and practitioners have become accustomed to reaping the benefits of technology and insights in care provision. As pharmacies are held more accountable for the whole patient picture and rated on outcomes, harnessing the full potential of data sharing technology is not an “if,” but a “when” and a “how.” Pharmacy needs to be proactive in forging this path. The future of healthcare depends on it.