“The only way pharmacists will be paid for their medication-related services is if they can document their value.” The Pharmacist eCare Plan should be an excellent tool that pharmacists will be able to use to capture clinical data that payers are looking for to reimburse pharmacists for their services.
The opening quote has been made at countless conferences and seminars that I have attended the past 10 years. We have studies, white papers and U.S. Surgeon General reports providing massive amounts of data detailing the value of pharmacist services in improving patient care, decreasing the overall number of hospitalization and re-admissions, and reducing the total net health care spend. This information has been shared with payers that are being asked to reimburse pharmacists for their services, yet they still ask for more documentation. Centers for Medicaid and Medicare Services (CMS) is also seeking documentation. CMS currently has a program “Part D Enhanced Medication Therapy Management Model” designed to test whether high quality, “enhanced’ medication management can save money and improve the quality of health for seniors. As part of this program, CMS has developed new MTM related data and metric collection requirements for monitoring and evaluation purposes.
The Pharmacist eCare Plan is a tool that will enable pharmacists to collect, document and share medication-related services with providers, payers, and care givers (as well as the patients themselves) and thus validating the pharmacist’s role in patient care. Capturing clinical data is what payers are looking for to reimburse providers for disease state management, drug therapy management and chronic care management.
I recently reviewed the “Pharmacist eCare Plan Basics” presentation posted on the CPESN website and was able to get an excellent overview of the Pharmacist eCare Plan. Contrary to popular belief, the Pharmacist eCare Plan is a standard, not a platform, that contains the latest clinical data for a given patient. It is an “open” standard anyone can use. It can work with any system that has adopted it and the specs are published.
Advantages of the Pharmacist eCare Plan
- Pharmacy choice of technology vendor
- Captures pharmacist patient care information
- Pharmacists own the clinical data and may direct it where they desire
- Specifically designed for data exchange using standardized data
The data is standardized in part by use of national libraries of codes, such as SNOMED CT. The national standards allow care plans to be exchanged with medical providers and care managers. SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) codes are a list of value sets owned and distributed by the International Health Terminology Standards Development Organization (IHTSDO). SNOMED CT codes can be used to represent clinically relevant information consistently and reliably. Of the hundreds of thousands of SNOMED CT codes, approximately 300 have been identified as useful for documenting medication therapy management services. For more information access the SNOMED CT Implementation: A Beginner’s Guide (PDF), also available via our Online Resources (Pharmacy HIT Collaborative).
Basic Pharmacist eCare Plan Functionality
The functionality has been designed to align with the Joint Commission of Pharmacy Practitioners (JCCP) Pharmacists Patient Care Process which included the five components:
1. Collect 2. Assess 3. Plan 4. Implement 5. Monitor/Evaluate.
The functionality includes:
- Patient Demographic Information
- Encounter Reasons and Type
- Payer Information
- Prescription Fill History and/or Active Medication list
- Medication Therapy Problems
- Interventions and Education
- Care Coordination
- Patient Goals
The Pharmacist eCare Plan could be used in disease state management, transitional care and whole person medication management. But what about access to lab results? Immunizations?
Advanced Pharmacist eCare Plan Functionality
The Pharmacist eCare Plan is a work in progress. As the eCare plan continues to mature, additional plan functionality should include:
- Problem Observation and Encounter Diagnosis
- Self Care Activities
- Mental Status Observation
- Smoking Status
- Functional Status Observation
- Lab Results
- Social History
- Vital Signs
- Caregiver Characteristics
The “eCare Plan Basics” presentation provides an example of the Pharmacist eCare Plan in Practice and how a pharmacist would document the services provided to an asthma patient. Using the codes provided, the pharmacist could document all the steps taken in caring for the patient from the initial encounter to identification of therapy problems to the all-important interventions that will improve patient care.
View the “Pharmacist eCare Plan Basics” presentation. Stay tuned as Value Pharmacists continues to monitor and report new Pharmacist eCare Plan developments.