As healthcare spending continues to rise, the question of how to control costs while maintaining—or potentially improving—outcomes becomes increasingly more important.
For John Tovar, PharmD, associate professor and chair of the Department of Pharmacy Practice at PCOM School of Pharmacy in Suwanee, Georgia, finding an answer to this question is a matter of urgency since the healthcare system, as he sees it, is crumbling under the strain.
“We have to do something about it,” he said. “At the rate we’re going, health care debt will continue to prompt even more bankruptcies among patients.”
Tovar has always been passionate about reducing healthcare costs, but acknowledges the limitations of his profession.
“Obviously as a pharmacist you only have control over one specific area,” he said.
He hopes to change that through advocacy for a more collaborative model—one in which pharmacists are more involved in patient care.
As a pharmacist at a Texas teaching hospital, Tovar had the opportunity to work with physicians, residents, medical students and pharmacy students as part of a patient care team. In that role, Tovar was responsible for the medication-related aspects of the patient’s care. He also ran an outpatient clinic where he worked to ensure each patient’s medication was prescribed and adjusted to meet that individual's specific needs.
“There are a lot of drugs out there, but the right one can depend on the patient,” he explained.
In working with diabetic patients, Tovar noted that patients referred to him was not getting the correct type and dose of insulin. By working with the patients and making medication adjustments, Tovar was able to help his patients use less insulin and achieve better insulin control.
“We’re trained to pick the best drugs for the patients,” he added.
This knowledge, he said, means pharmacists are well-positioned to contribute to better healthcare outcomes. With better medication management, adverse effects from poorly controlled conditions such as diabetes or high blood pressure can be mitigated thereby improving patient outcomes and reducing healthcare expenditures.
“The current model is not working,” Tovar emphasized. “It’s not going to help improve those outcomes. Let’s work together on the front end so the outcomes are better”
So what does a collaborative model of health care look like?
Tovar believes including pharmacy consultations as a standard component of patient care would be one way to help physicians and pharmacists provide better patient care while lowering costs. These consultations would provide an opportunity to review medication options and create an individualized treatment plan.
The main obstacle to that, he explained, is that insurance companies currently have extremely low reimbursement rates for pharmacy consultations because Medicare does not recognize pharmacists as providers—despite the role they can play in lowering prescription spending, improving disease control and reducing hospitalizations.
“When you add all those direct and indirect costs, any billing by a pharmacist is going to be more than offset by those savings,” he said.
While low reimbursement rates currently make it difficult for hospitals and other healthcare organizations to offset the costs of having a staff pharmacist, that may be changing.
Insurance companies, Tovar said, are increasingly looking to reward performance based on patient outcomes. By adding staff pharmacists, medical providers could more easily meet benchmarks of care. The financial rewards from achieving these goals could cover any pharmacist salary cost.
As an associate professor at PCOM School of Pharmacy, Tovar knows that changing how pharmacy is practiced begins with the instruction delivered to the pharmacy students of today.
“We’re not just talking about it, we’re trying to do something about it,” he said.
Through innovative new learning strategies and hands-on experience in managing patients, PCOM pharmacy students are gaining the skills needed to holistically assess each patient and decide treatment strategies based on practical exercises which emphasize collaboration with the patient’s healthcare team.
According to Tovar, students enjoy the new teaching methods and are better prepared to enter the workforce or pursue pharmacy residencies. And this, he said, means PCOM School of Pharmacy is moving in the right direction to ensure student success.
“We want to give them the skills to allow them to be the pharmacy practitioners of the future.”
Article updated Jan. 26, 2023 as follows:
Dr. Tovar’s quote originally read as “At the rate we’re going, it’s going to bankrupt the country.” This was updated to read as “At the rate we’re going, health care debt will continue to prompt even more bankruptcies among patients.”
This statement: "In working with diabetic patients, Tovar noted that every patient referred to him was not getting the correct type of insulin." was updated to read: "In working with diabetic patients, Tovar noted that patients referred to him were not getting the correct type and dose of insulin."
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