This is a lightly edited version of a story in Breakthroughs magazine.
Let’s say you’re a patient with diabetes. The keys to keeping your condition under control are diet, exercise, medication – and regular monitoring to keep your blood sugar in check.
In many medical practices, a doctor or other medical provider may see you every three to six months to determine whether medication modifications are needed. But at Community Care Physicians in the Capital Region, you’ll talk to a provider monthly, and medication may be adjusted as frequently as every two to four weeks, keeping blood sugar levels at more optimum levels.
In a pioneering model that is making an important impact on the management of diabetes and other chronic diseases, that provider will be a pharmacist.
Through an arrangement that Albany College of Pharmacy and Health Sciences helped launch in 2015, the primary care practice has integrated pharmacists into patient care. As of April 2023, CCP had 8.5 full-time equivalent pharmacists on staff.
The model offers benefits to patients, the primary care practice, insurers and to ACPHS, which shares a pharmacist with CCP and sends students and residents through the medical practice for training. It’s also good for the practice of pharmacy: pharmacists work to the full extent of their training, engaged in patient care in collaboration with medical providers.
“In the end, it’s a win for the community,” said Dr. Lou Snitkoff, the retired chief medical officer CapitalCare Medical Group and later CCP.
Dr. Snitkoff launched the integration of pharmacists into CapitalCare, with ACPHS Associate Professor Alexandra Watson ‘14 (pictured above, right) among the first to join the practice. The two met while Dr. Watson was completing her residency at the Samuel S. Stratton Department of Veterans Affairs Medical Center in Albany. Dr. Snitkoff, the husband of then-ACPHS Associate Professor Gail Goodman-Snitkoff, understood that “pharmacists were educated to do more than count pills” – that they were experts in medications who could counsel patients.
At the time, Dr. Snitkoff was charged with determining how CapitalCare could succeed in light of an emerging change in payments from health insurers. In primary care especially, a prominent Capital Region health insurer was moving away from paying the practice for each service provided toward “global” payments, in which the practice received a set fee for providing all the care to the insurer’s members. Under the new arrangement with Capital District Physicians’ Health Plan, Inc. (CDPHP), CapitalCare earned more money if it kept patients healthier and limited unnecessary treatments.
Dr. Snitkoff saw the value of bringing pharmacists into the fold to help manage the health of people with chronic diseases, so they did not get sick and require costly remedies. Dr. Watson was the second pharmacist to join the practice; CapitalCare shared her salary 50/50 with ACPHS, where she taught in the Department of Pharmacy Practice.
Dr. Watson was initially embedded in the quality department, where her role involved determining whether patients were on the right medications and improving adherence to medications through patient education. She also worked at two practice sites directly with medical providers and patients on medication management.
Because she could not directly bill for her services, Dr. Watson had to show that her contribution contained costs. She helped provide information on how quality of care could be improved at the organizational level, looking especially at tough-to-manage chronic diseases that affected many patients, like diabetes and asthma.
It took time to develop trust among some of the providers, she said, who saw pharmacists’ role as one of dispensing meds. But her value became so clear that within two years, CapitalCare hired two additional pharmacists – embedded in care management rather than quality assurance, looking at high-risk populations.
Meanwhile, another ACPHS alum, Dr. McKenzie Janoszewski ‘05, was filling a similar role at CCP. When the two practices merged (the CCP name remained), Dr. Janoszewski became director of clinical practice for the large combined medical group, which now dominates primary care in the region. She was able to show multiple benefits to patients and physicians of expanding the number of pharmacists in the group (see below). They built a residency program spearheaded by Dr. Watson and added to pharmacists’ roles.
Dr. Raelyn Passino ‘18 was a student of Dr. Watson’s at ACPHS who became a resident at CCP and was then hired to work at their Latham Medical Group office in July 2020. She works with interdisciplinary teams comprising physicians, PAs, nurse practitioners, behavioral health consultants, population health specialists and certified diabetes educators.
“My experience here has been rewarding and collaborative,” she said.
Pharmacists’ contributions to such clinical teams are invaluable in light of an ongoing shortage of primary care providers, noted Dr. Darren Grabe, chair of the ACPHS Department of Pharmacy Practice. Indeed, when pharmacists help manage medication therapy and chronic disease as well as educate other health care providers and patients, then the other providers can spend more time with patients confronting serious illnesses.
“They’re doing the communication with patients. They’re doing the explanations. It helps free up my time to deal with other fires,” said Dr. Cindy Chan, a board-certified internist at CCP (pictured above, left).
One of the drivers of the transformation, the health insurer, has been pleased with the integration of pharmacists into CCP’s practice.
According to Eileen Wood, executive vice president and chief pharmacy officer at CDPHP, “We love it, because it makes them more successful, which makes the patients healthier, which reduces avoidable costs.”
Pharmacists in Primary Care Get Results
The benefits of having pharmacists help manage patients with chronic diseases at CCP have included:
- A reduction in tests of blood sugar levels for patients with diabetes
- Use of lower-cost medications with the same outcomes decreased expenses
- Decreased medication-related hospital admissions through the identification of potential drug interactions
- Decreased hospital readmissions due to medication reconciliation when patients are released from a hospital to home
- Doctors are able to see more patients because of the reduced time spent on drug-related questions
- Doctors get real-time updates on new drugs, changes to covered prescriptions and immunization practices
Source: Dr. McKenzie Janowszewski, director of clinical services, Community Care Physicians