Pharmacist and Physician Led Chronic Care Program Improves Hypertension

A chronic care management (CCM) collaboration between community pharmacists and primary care physicians led to a meaningful improvement in blood pressure for Medicare beneficiaries with uncontrolled hypertension. Moreover, the CCM model nearly doubled revenue for the community practice and the physician group, according to a poster presented at the 2019 NCPA Annual Convention. 

The collaboration was established by the Northeast Iowa Family Practice Center (NEIFPC) and the Greenwood Pharmacy and Compounding Center. For the experiment, the primary care facility allowed the pharmacy to document interventions directly into their EHR. By the end of 9 months, the number of billable claims increased three-fold, and the services provided resulted in a mean drop in systolic blood pressure of 7.3 mmHg and a decline in diastolic pressure of 3.0 mmHg. 

"This collaborative CCM hypertension project between a community pharmacy and primary care physician clinic was successful at improving patient blood pressure in a financially viable way," write the authors of the paper, led by Robert Nichols, PharmD, from Greenwood Pharmacy and Compounding Center, wrote in their abstract. "Community pharmacists demonstrated their ability to modify drug therapy, document patient care notes in the clinic EHR, and receive CCM payments for services. Clinic CCM revenue also increased."

Eligible patients enrolled in the CCM through NEIFPC had a blood pressure >130/80, with a mean of 140.4/77.9 mmHg. The mean age was 70.7 years, and a third had diabetes (34.6%). A quarter of patients were receiving at least 3 antihypertensives (26.9%), with the majority receiving 2 (46.2%). Revenue from the collaboration was shared between NEIFPC and Greenwood, based on a predefined formula (52.3% to 47.7%). Measures of time effort were gathered using Dulcian Health. 

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Overall, the program included 26 patients who visited the pharmacy at least once. There were 6411 minutes of CCM service provided throughout the 9 months of the project, which was divided evenly between the primary care facility (3390 minutes) and the pharmacy (3021 minutes). 

At 9 months post-initiation, the mean blood pressure was 133.1/74.9 mmHg, which was a meaningful decline from baseline (P = .02). There were 98 patient notes recorded by the pharmacists, with a total of 18 changes in blood pressure medication required throughout the project. 

The CCM collaboration billed 142 claims, significantly above the 57 claims in the physician practice alone during the same time frame. The total revenue throughout the project was $5842, which was significantly more than the $2535 for NEIFPC alone. Revenue in the combined group was divided as $3057 for the primary care site and $2785 for the pharmacy, both of which were above single institution expectations. 

Of the claims, 100 were 99490 (CCM), 26 were 99487 (complex CCM), and 16 were 99489 (additional complex CCM). The revenue gained per the hours spent equated to $55.30 per hour for community pharmacist time. 

"Community pharmacists were successful in modifying drug therapy and documenting patient care notes in clinic EHR," the authors wrote. "Future CCM revenue sharing may be simplified by using proration, based on overall time rather than by per claim analysis of time effort."