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Iowa PCM: Expansion

Written by Kate Puetz, PharmD
Director, Professional Programs
Iowa Pharmacy Association
Des Moines, Iowa

As a third column in a three part series, it is important to recap as well as wrap up the topic that we have been discussing – pharmaceutical case management (PCM).

First, to recap – the first column discussed some of the hurdles that had to be overcome to make PCM a reality. Although there were components of the final legislation that were less than ideal, a lesson was learned “don’t let perfect be the enemy of good.” Less-than-perfect opportunities can be very rewarding, and the second column looked at steps pharmacists must take to achieve such rewards. Just as pharmacists devise action plans for patients following a PCM assessment, we must devise action plans for patient care at our practice sites. Pharmacists need action plans to increase the quantity and quality of patient care services we provide, as well as increase the revenue we are able to generate from these services.

Next, to wrap up – fortunately, there is no end to this story. Instead the story of pharmaceutical case management is only part of the beginning. Medication therapy management services such as PCM will continue to expand as more pharmacists continue to provide these services to their patients.

The most recent expansion of PCM has been into the private sector, through partnerships between the Iowa Pharmacy Association (IPA), the Iowa Farm Bureau Federation (IFBF) and Wellmark Blue Cross and Blue Shield of Iowa. With grant funding from the Community Pharmacy Foundation, over 250 eligible Farm Bureau members are able to receive PCM services from their local pharmacist. Approximately 100 pharmacists in Iowa are currently participating in this 12 month pilot program, which began February 1, 2006.

Although the eligibility criteria and basic care processes are identical to the Iowa Medicaid PCM program, there are several differences that exist. In Iowa Medicaid PCM, both pharmacists and physicians are reimbursed for the care provided, while only pharmacists are reimbursed in the Farm Bureau/Wellmark program. Also new to this program, certain PCM eligible patients are enrolled in other care management programs offered through Wellmark such as disease management and case management. Pharmacists and the clinicians who provide disease management and case management have an additional opportunity for collaboration. During this program, collaborations have been facilitated by project coordinators from IPA and Wellmark. For patients enrolled in disease management, the pharmacists and disease managers are alerted to the patient’s status and may address the collaboration as well as reinforce important disease state management techniques. Pharmacists providing care to patients enrolled in case management and PCM have the opportunity for more intense collaboration via conference calls between the two providers. This has assisted pharmacists prior to performing the initial PCM assessment, as case management patients often have complex issues difficult to infer from reviewing a patient’s medication profile.

Following the initial 12 month study period, the outcomes of this pilot project will be evaluated, including health care utilization, health outcomes, quality of life indicators, and the financial impact of PCM services.

Hopefully, after reading all three parts of this series, you are able to see the ongoing process and hurdles that exist for pharmacists providing medication therapy management services and expanding their roles as providers. As with PCM, there is no wrap up, or conclusion to the story, but rather a drive to continue to expand services and increase the number of patients that can be reached. Although the Farm Bureau project reaches a relatively small number of patients, every bit counts as pharmacists work to provide an evidence-based approach to demonstrate the value we can bring to the health care system.