Panther Profiles are Q&A interviews that highlight Panthers of all stripes -- students, faculty, staff, alum, board members and anyone else in the campus community.
Associate Professor Dr. Alexandra Watson ’14 splits her time between teaching pharmacy students and practicing as a pharmacist at Community Care Physicians, the largest primary care practice in New York’s Capital Region. Dr. Watson tells us about the important role she played in integrating pharmacists into medical practice in upstate New York.
You have helped pioneer a role for pharmacists in medical practice in New York’s Capital Region. Is that anything like the career you imagined?
All through school, I worked in community pharmacy, and I saw myself going into community pharmacy. The pharmacist that I worked under was very patient-forward. He exhibited that a pharmacist’s role wasn't just filling prescriptions; it was making sure patients understood what they should be doing regarding their medications.
I also got a residency at the Albany VA (the Samuel S. Stratton Department of Veterans Affairs Medical Center). In federal facilities like the VA, pharmacists have a broad scope of practice: they can prescribe medications, they can order labs. As long as the patient has a diagnosis, pharmacists can help manage it. I got to see what it was like to work with the medical provider and the patient to come up with medication therapies and manage the meds. I liked that combination of patient aspect and clinical aspect, as well as the decision making, directly with the provider.
How did you come to work at Community Care Physicians?
Towards the end of my VA residency, I was looking for my next job. Dr. Lou Snitkoff was the chief medical officer at CapitalCare Medical Group. CapitalCare had a pilot with CDPHP (Capital District Physicians’ Health Plan, Inc., a health insurer) which engaged pharmacists in patient care. But the pharmacists could only work with CDPHP patients. Dr. Snitkoff wanted a pharmacist that could reach out to all patients. His wife, Dr. Gail Goodman-Snitkoff, had worked at ACPHS, so he had ties here. He reached out to the College to say, can we split a pharmacist? That was in 2015.
What was your role initially?
When I first started at CapitalCare, I was part of their quality team. I couldn't directly bill for my services as a pharmacist. To show the benefit of having a pharmacist there, I worked with the department to close gaps, so to speak. We looked to see if patients should remain on certain medications based on their conditions, for example, or at ways to improve adherence to medications through patient education. The department would run reports so I could look at population health information to see how we could improve quality of care through medication management on an organizational level. And I was also embedded at two of the bigger CapitalCare practice sites to work directly with the providers on medication management for patients with tough-to-manage chronic conditions like diabetes and asthma.
Over time, more of the medical providers wanted pharmacists to answer questions and meet with patients. Since I wasn't directly billing and bringing in money, I was showing how we could justify adding more pharmacists through reduction of cost. I was there about two years when we hired two additional clinical pharmacists. Then I got moved out of the quality department and into care management.
Fast forward to 2019: we merged with Community Care Physicians, which also employed a clinical pharmacist. We suddenly had more than 40 primary care practice sites. We hired an additional pharmacist through contracting with insurance companies and worked with the College to create a residency program. In addition to chronic disease management and medication management, pharmacists began to be involved in wellness visits. They were doing preventive screenings and making sure patients were up to date on colonoscopies and bone mineral density testing in addition to assessing medication. Now we have pharmacists doing annual wellness visits, and they bill for those services underneath the nurse practitioner.
How have medical providers responded to having pharmacists on the patient care team?
When I first came in, they were like: What are we going to do with this pharmacist? We don't have a dispensing pharmacy, so why are they here?
I had to show my value. One of the first things I did was a report of patients that were on acid reflux medications for years, questioning whether the patients still needed the medication. I told the medical providers, I can either flag their chart so that you could talk about it at their next visit, or, if you're comfortable, I can reach out to the patient and talk to them about it. They usually said, the less on our plate, the better. I showed the providers a full script of what I would talk to patients about; I laid everything out so that they were comfortable with me doing it. At the end, I was able to show how many patients could get off this often unnecessary medication.
They trusted me after that. They started referring me to more patients and asking me questions. It took building trust and showing them what a pharmacist could do.
Is there a simple example of how your role has changed over the years?
I used to get a lot of cost and formulary questions: “What medication is covered?” I can help with that. But sometimes my answer was, “This medication is covered, but it's not the most appropriate medication. How about we switch to something else?”
Now, a lot of my work is keeping up with new medications. I get a lot of questions about patients who are on a recommended medication but their condition is not controlled: “What do I do next?” There's always new medications or guideline changes that are hard for providers to stay on top of. They can ask me about what to do next, based on what other meds the patient is on, or what other conditions they have.
I work hand in hand with the provider, usually talk with the patient to make recommendations and then get the provider to sign off.
More about Dr. Watson’s role in integrating pharmacists into the Community Care practice is in Breakthroughs magazine.