Offering cognitive services through consulting
Offering cognitive services through consulting
A Connecticut pharmacy consulting group plans to test whether payers will buy pharmacy cognitive services, such as disease management, on a contractual basis from pharmacists not employed by a health system. Since pharmacy benefit management (PBM) companies are rapidly moving into disease management, this would seem likely if the small company can convince payers their skills are equal to or better than the bigger PBMs.
Based in Glastonbury, CT, Perry Cohen and Mike Sax, both PharmDs and partners in The Pharmacy Group LLC, are embarking on payer-driven networks linking their services with dispensing chains and payers like insurance companies. (See schematic of network, below.)
"The name of the new game is not how much you’re billing but how much you’re saving," Cohen says. They plan to approach a payer in a defined geographic area or with a defined patient population and analyze any problems seen with their costs. "You start by looking at the utilization of drugs, the overuse or underuse, and find ways to lower the costs, and then see whether there’s interest in paying a pharmacist to manage a specific disease state and cut those costs."
From there, local pharmacists would be hired as project managers, while Cohen and Sax provide pharmacoeconomics input. "This way, you’re driving the process from the payer perspective," says Sax, adding that payers also could team up with a drug manufacturer, if desired, to target a specific disease state with limited or multiple drugs.
Cohen and Sax initially will target high-cost disease populations such as patient groups with asthma, diabetes, cardiovascular diseases, depression, or hypertension. "There’s a need in the community market for this. The pharmacists are close to the medication and are close to the access points at the chains," Sax says.
For their first project, they plan to focus on anticoagulation. "You have to start with commonplace conditions that are well understood and have a well defined pharmacotherapy. Anticoagulation has drug interaction and noncompliance issues, and there’s therapeutic range monitoring that can save unneeded hospitalization. And finally, it can show a quick outcome," Cohen says. "If we’re lucky, we’ll have three pilot programs up in 1998, and hopefully by the end of 1998, we’ll have pharmacists seeing patients. The next challenge is going to the physicians to have the patients clinically managed by the pharmacists. And then the challenge is getting the patients to go along."
[For more details, contact: Daniel Buffington, PharmD, MBA, University of South Florida College of Medicine, 3500 E. Fletcher Ave., Tampa, FL 33613. Telephone: (813) 971-7440. Dale Christensen, PharmD, University of Washington School of Pharmacy, Seattle. Telephone: (206) 543-1412. Perry Cohen and Mike Sax, The Pharmacy Group LLC, P.O. Box 129, Glastonbury, CT 06025. Telephone: (860) 633-0062.]
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