Ambulatory Pharmacists Emerge as Key Players in Value-Based Care Models to Address Rising Drug Costs
Key Insights
Ambulatory clinical pharmacists serve three critical roles in value-based care: managing chronic diseases, preventing hospitalizations through population health outreach, and providing financial expertise on medication costs.
These pharmacists help keep high-risk patients with conditions like diabetes (search), heart failure, and hypertension (search) out of hospitals by managing complex medication regimens and ensuring adherence through technology-enabled outreach programs.
With new medications costing over $5,000 per dose, pharmacists' expertise in drug pricing is becoming essential for health systems to negotiate contracts and avoid financial losses from high-cost therapies.
Ambulatory clinical pharmacists are taking on expanded roles within value-based care models as healthcare systems grapple with exponentially rising medication costs and the need to improve patient outcomes while controlling expenses. Caroline Vovan, PharmD, CDE, director of ambulatory care pharmacy at the Providence Clinical Network (search) in California, outlined how these specialized pharmacists are bridging critical gaps between clinical care and financial sustainability.
Three-Pronged Approach to Value-Based Care
Vovan described the role of ambulatory clinical pharmacists in value-based care models as encompassing three distinct but interconnected functions. The first two focus on traditional clinical responsibilities, while the third addresses the growing financial pressures facing healthcare systems.
"We are really trusted providers by the physicians," Vovan explained. "The physicians also see us, and the patients, too, see us, as clinicians, where we really do know how to manage diabetes (search) and other difficult cardiovascular diseases, like congestive heart failure (search), hypertension (search), [and] hyperlipidemia (search)."
The primary clinical role involves taking complex chronic disease management responsibilities off physicians' plates, allowing doctors to focus on patients with more acute conditions while pharmacists provide intensive support for chronic disease patients who require more hands-on management.
Population Health and Hospital Avoidance
The second clinical function centers on keeping patients out of hospitals through proactive population health management. Ambulatory pharmacists work with pharmacy technicians and students to conduct regular outreach to patients, ensuring medication adherence and addressing barriers to treatment compliance.
"It's with our pharmacy technicians and students, where they're talking to them on the phone, making sure they're adherent to their medications, asking them, 'Is there a reason why you can't take it? Is it too expensive? How can I help you?'" Vovan said.
This approach specifically targets high-risk patient populations with conditions that historically lead to high hospitalization rates. The focus includes patients with diabetes (search), heart conditions, and stroke (search) risk, using medications proven to prevent hospital admissions such as ACE inhibitors (search), angiotensin receptor blockers (ARBs), and statins (search).
Providence receives weekly lists of thousands of patients whose medications need refills, utilizing technology and text messaging to remind patients about medication adherence and prevent treatment gaps.
Financial Expertise in High-Cost Drug Era
The third and increasingly critical role involves financial stewardship as medication costs continue to escalate. Vovan noted that new medications in the pipeline rarely cost less than $5,000 per dose, creating significant financial challenges for healthcare systems.
"As pharmacists, we really do know our medications, and we know the cost of the medications," she emphasized. "We are not only helping the patients' pocketbooks, but we also want to help our medical group or our health systems' pocketbooks, as well."
Contract Negotiation and Risk Mitigation
Looking toward future innovations in ambulatory clinical pharmacy, Vovan highlighted the need for pharmacists to become more involved in contracting and negotiation processes with health plans. She argued that pharmacists' deep understanding of medication costs and treatment options positions them uniquely to help health systems avoid financial losses.
"Our financial people are just not aware of how much these things cost now," Vovan observed. "As pharmacists, we know the cost, and our health systems are oftentimes at a loss because they did not negotiate enough to even cover the cost of the medications, not to mention all the staffing and overhead that is involved."
This expanded role represents a shift from traditional disease management functions toward broader population health and financial responsibilities, reflecting the evolving needs of value-based care models where providers assume greater financial risk for patient outcomes.
The integration of ambulatory clinical pharmacists into multiple departments at Providence demonstrates how health systems are recognizing the value of pharmaceutical expertise beyond traditional clinical roles, particularly as medication costs continue to challenge the financial sustainability of value-based care arrangements.