Integrating population health into everyday pharmacy practice
“Pop health is not something that occurs on the side of a desk by a silent group of individuals. It truly is something that has to be integrated into the entire organization.”
In late 2015, Charles McCluskey embarked on a quest with a half-dozen other clinical and functional leaders from OhioHealth to build a population health strategy from scratch.
Fast forward three years—and countless data reviews, strategy sessions, outreach meetings, community assessments, and gallons of coffee—and McCluskey’s pop health pharmacy staff was managing multiple programs benefiting approximately 35,000 attributed lives. The programs continue to evolve today.
At the same time, McCluskey oversees all of OhioHealth pharmacy lines, including operations for all hospital pharmacies, hospital-based clinics, retail/discharge pharmacy, clinical practice sites with physician offices, and home infusion.
“As pharmacists,” he said, “we have a lot of unique capabilities that bring value to the population health space. We’re just starting to hit our stride. We have a lot more to give.”
Q: What are some of the population health programs you’re implementing today?
A: We currently offer several that I describe as direct-to-patient programs. Some of these include diabetes prevention, diabetes management, asthma management, and medication therapy disease management. More are in development. It’s a model that is aligned closely with care management in the sense that care management typically has an algorithm that defines high-risk patients based upon risk. So, we work to determine which patients of the population are at greatest risk, and then determine the type and level of outreach required to improve outcomes.
Q: Do you look for different skill sets in your population health pharmacy staff?
A: In some ways it’s a very similar set of skills. I expect our trained pharmacists and certified pharmacy technicians to conduct patient interviews and to have effective interactions with physicians and colleagues. What’s different today is the modality.
Ten years ago, it was all about delivering live care and sitting across the table from the patient. Now, we’re finding a significant portion of our work involves telephone and video visits. That requires a bit different set of skills. Over the phone, you have to engage with patients and assess their needs in different ways while conveying a message of support and compassion. That’s much different than a face-to-face experience.
Q: What other skills do you look for in your population health pharmacists?
A: It requires an individual to think beyond medication management and medication adherence and to understand the overall dynamics within the care management portfolio, including care resources not necessarily tied to the health system.
Because it's truly that virtual patient-centered medical home concept. It may have been a buzzword before but it’s a reality today.
For pharmacists and certified pharmacy technicians, it means understanding their own skill sets. It also means understanding the social determinants impacting patient care, and the other players and their roles, and the right time to actually engage the dietician, social worker, case manager, or behavioral health specialist.
Q: You use the term “impact ability”—how do you define it?
A: In addition to risk, we look at the ability to impact a patient. One of my team members used a great example just the other day.
A patient could have a very high hemoglobin A1C test result of 13. But in reaching out to the patient, the pharmacy team learns that the patient’s biggest challenge is not necessarily medication access. Rather, the patient is struggling with access to food. Or access to transportation. Or access to a variety of other services.
Now, as a collective health system, we want to help this patient. From a pharmacy perspective, we have to realize when to access other services for that patient. The pharmacist can bring in a dietician, for instance, to work with the patient on food utilization. Or bring in a social worker to overcome transportation barriers.
With those basic needs met, now pharmacy can have a conversation around medication management.
So, it takes a completely different approach. If you think about it, that’s how healthcare treated patients in the past.
Q: What adjustments have you made since launching your pop health initiatives?
A: Pop health is not something that occurs on the side of a desk by a silent group of individuals. It truly is dynamic and something that has to be integrated into the entire organization.
In the last several months, my focus has been tying all the work done in the pop health space into pharmacy operations within the health system. That includes bringing along everyone from the leadership team to frontline pharmacy associates. It means explaining what population health is, what the leadership structure looks like, and the changes to be made in order to make it work.
In fact, to illustrate this point, just this week I announced a change to the organizational structure. I created a new role of Senior Director of Pharmacy Services for Population Health, and I realigned the other directors under this role for the sole purpose of breaking down siloes and strengthening relationships across the whole care continuum.
Q: What excites you about pharmacy’s role in population health?
A: When I talk to colleagues and network at conferences, I hear lots of questions and apprehension. Healthcare has a significant negative impact on the overall financial health of the U.S. economy. There’s uncertainty about what the government is going to do about healthcare overall and specifically about alternative payment models. And pharmacy leaders are questioning that impact on their health systems, on operations, and on reimbursement models. My approach is, let’s embrace it. Let’s figure out how to make it work.
Pharmacy is actually in a position to help lead change. Not only from a cost perspective, but by creating different service levels, how we interact with patients, how care is delivered, and how quality outcomes are achieved. That’s what excites me. As pharmacists, we can take the lead on where healthcare is going.
Q: What do you see as the biggest challenge to effective execution of a population health strategy?
A: The biggest challenge is data. We've all heard the phrase that data is king. In population health, data is extremely important. We want to know as much about the patient as we can get our hands on—medical records, claims data, any patient-specific data that allows the care team to truly understand who is at need and how we engage them. I’m unaware of anybody that is actually doing this kind of data collection and data mining at the highest levels today.
Going back to social determinants, I feel that Kroger, for example, has a better idea of what foods a patient buys and eats than the healthcare provider does. That’s an invaluable data resource we need to consider. As a clinician, I may not necessarily need that data right now, but just knowing that data is out there could actually simplify processes when and if you do need dietary information.