As advocates for patients, beneficiaries and members, case managers play a critical role in coordinating care, managing chronic conditions and improving overall health for people with complex medical needs. Having the right resources to support important aspects of care, like medications, is critical to enabling success.
Pharmacy services can play a key role in helping improve disease state management and better clinical outcomes, complementing the work case managers do to elevate care and enhance wellbeing. But not all pharmacy models provide the same level of support.
Traditional models, like retail or mail order, are transactional in nature. This may be the right fit for someone taking one or two medications. But a more comprehensive pharmacy approach takes into consideration the complex needs of people managing multiple chronic conditions, offering specialized support to help them stay healthier and more independent at home.
By leveraging comprehensive pharmacy care, case managers can streamline their approach and maximize success.
Assessing and Overcoming Barriers to Med Management
When case managers complete in-person or virtual assessments to identify patient needs, they might uncover issues with medication management. If patients do not take their medications as prescribed, it can lead to negative health outcomes and unnecessary healthcare utilization.
Importantly, patient needs can change quickly. Comprehensive pharmacy complements case manager assessments by identifying and helping overcome barriers to medication management, including issues remaining adherent, which are widespread. In fact, in the U.S., three-quarters of people have trouble taking their medicine as directed.
Common reasons for nonadherence include:
- Access. Patients may not live near a retail pharmacy, or pharmacy closures might impact them. Alternatively, issues with transportation or mobility could prevent them from consistently picking up their prescription and over-the-counter meds. Monthly delivery of prescriptions and non-prescriptions with synchronized refills helps streamline medication management.
- Forgetfulness. Patients might accidentally skip doses of their medications, which can impact efficacy. Electronic reminders help patients stay on track with their daily med routines.
- Complexity. Patients with multiple chronic conditions might take 10 to 20 pills a day, making it difficult to stay organized. Time-of-day dose packaging makes it easier to take medications as prescribed.
- Side effects. If a medication causes side effects that interfere with a patient’s daily activities, they may stop taking it. Monthly medication reviews provided by clinical pharmacists monitor for potential problems like drug interactions and drug duplications, which can cause side effects and lead to unnecessary ER visits and hospitalizations. Research has demonstrated a 10.3% decrease in ER visits and a 10% reduction in annual hospital admissions with medication safety reviews.
- Education. Patients might also stop taking medications if they don’t feel a difference. A common example is statins, which can help lower cholesterol even if patients can’t feel them working. One-on-one counseling helps patients better understand their medications, why they are important and how to take them as prescribed. AnewHealth data show 94% adherence rates for diabetes, cholesterol and hypertension medications, respectively, with comprehensive pharmacy.
Taking the Complexity Out of Pharmacy Care
With comprehensive pharmacy support, case managers communicate one-on-one with an account manager, allowing case managers to check in on their patients and ask questions. This often reduces the number of calls case managers make to doctors’ offices, which lowers administrative burden. Of note, it’s important for case managers to fully leverage their dedicated account manager, who can share insights and serve as a direct resource, making communication key.
A more comprehensive pharmacy approach complements the work of case managers and helps bring peace of mind to case managers and their patients. This approach goes beyond medication dispensing and delivery with personalized medication management that is crucial to supporting people with complex daily med routines, which can be especially confusing and difficult to manage. As a result, this high level of pharmacy support is integral to patient care, helping improve outcomes and making it easier for both patients and case managers to navigate the healthcare journey.
Learn more about how comprehensive pharmacy complements case management.
