Doctors and pharmacists unite to improve outcomes

Physicians and pharmacists are working more closely together through a series of collaborations between some of the nation's largest physician groups and Walgreens, one of the largest drugstore chains.

Relationships vary among the physician groups, but each are designed to save money in medical costs and result in higher payments from insurance companies that are rewarding physicians who show that they are improving their quality of care.

"Giving physicians further insight into patient behaviors and working with them to spend more time talking with patients can help reduce health care costs and, more importantly, improve a patient's overall health," said Kermit Crawford, Walgreens' president of pharmacy, health and wellness.

One of the broader agreements is with Johns Hopkins Medicine in Baltimore. The four-pronged approach includes education, research, program development, and clinical protocol development and review to improve outcomes of patients with chronic diseases.

"The education part of this mission would result in better use of pharmacists. That's better for business and better for patient care," said Fred Brancati, MD, MHS, medical director for this collaboration under his role as director of Johns Hopkins Medicine's Office of Business Development and Strategic Alliance.

He said Johns Hopkins will provide educational and training programs that instill "the Hopkins approach" for Walgreens physicians, pharmacists, nurse practitioners, nurses and others in the health care field across the country.

Under the agreement, Johns Hopkins Medicine will:

• Develop ideas for research in disease management, screening and prevention that will spin off into proposals for grant funding.
• Work closely with Walgreens to review and improve patient care.
• Explore the possibility of jointly developing lifestyle, chronic care and disease-specific programs.

"For the short term, I see a lot of advantages in doing innovative work," Dr. Brancati said. "The long-run payoff could be for smaller practices. This would be a way to extend what they do after office hours to keep the patient healthy."

A pilot program with Northwestern Memorial Physician Group in Chicago, which has about 90 doctors, focuses on more timely communication and increased cooperation between Walgreens pharmacists and the physicians. The program is only for Walgreens and Northwestern Memorial employees who have NMPG as their primary doctors and have hypertension, diabetes, asthma or hyperlipidemia. These patients will receive on-site, confidential counseling and intervention from the pharmacist, who will relay the information to the doctor. (See clarification)

"The average person with a chronic illness is taking their medications 60% to 70% of the time," said Daniel Derman, MD, president of the NWM Physicians Group. "We can get it up to 90% with a coordinated approach between doctor and pharmacist. This program is looking at doing just that."

He said pharmacists know if patients aren't refilling their medications as they should, but they don't always tell physicians in a useful manner, such as before the doctors see their patients.

Dr. Derman said the program will be expanded to a broader group of patients and illnesses if and when it is proved that it can make a positive impact on patient outcomes and cost.

In another agreement, Walgreens Take Care Health Systems and Ochsner Health System in New Orleans will share information on Take Care Clinics and other health care options when Ochsner care settings are closed or unable to schedule an appointment within a patient's desired time frame. Take Care Health Systems is a Walgreens subsidiary that manages worksite health centers and in-store convenient care clinics.

In the U.S., Walgreens operates 7,689 pharmacies, and Take Care Health Systems has more than 700 locations.

Ron Weinert, vice president of health systems services for Walgreens, said the company doesn't have plans to expand its physician-pharmacist collaborations. However, he said the company's goal is to use models and programs such as this to play a larger role in the future of health care delivery.

Weinert said pharmacists have spoken with patients who have disclosed that they do not feel well and have not been taking their medication. When that occurs, the partnership has allowed for the primary care physician to reach out to the patient and revise the therapy plan, if needed.

"By providing that special attention to uncontrolled patients, we are avoiding a negative health event which keeps patients healthier and potentially saves payers the costs of hospitalizations," he said.