CMS Initiative Opens Door to Integrate Pharmacists into Patient Care

Patrick Wilson, R.Ph., BCACP, CDE

The Centers for Medicare & Medicaid Services (CMS) launched an initiative in October 2015 in order to improve the outcomes of patients with end-stage renal disease (ESRD), encourage better coordination of benefits and access to healthcare, and reduce costs. In this accountable care model, several ESRD Seamless Care Organizations (ESCOs) were created to bring together a wide range of healthcare professionals who are dedicated to providing care for the patient’s whole health rather than focusing on one episode of dialysis treatment.

Fresenius Medical Care is participating in six ESCO programs throughout the country—more than any other dialysis provider—because we know that integrated care improves patient outcomes, and we are committed to helping our patients.

We also understand that pharmacists are a key part of the integrated care team. Patients on dialysis are often prescribed 10 to 12 different medications[1], some of which must be taken multiple times per day. FreseniusRx pharmacists specialize in renal disease, which means we are uniquely positioned to partner with nephrologists, dietitians and other healthcare providers to ensure patients are appropriately dosed.

In fact, recent research showed that Fresenius Medical Care patients who were also on service with FreseniusRx were more likely to have better lab values[2] and fewer hospitalizations[3] than those patients who did not utilize the pharmacy.

Why Focus on ESRD?

As a whole, the healthcare industry is shifting from a fee-for-service model to value-based care. The Comprehensive ESRD Care (CEC) Model puts a spotlight on improving treatment for ESRD patients specifically because even though ESRD patients account for less than 1 percent of the total Medicare population, they account for about 7 percent of annual Medicare spending, according to the United States Renal Data System’s 2015 report.

To help ease the burden on the healthcare system while also providing the best care at an affordable cost for patients, this five-year initiative will analyze several markers of success, including care coordination, patient safety, quality of life, and patient and family satisfaction. The ESCO model is a shared-risk, shared-savings plan where each ESCO member is responsible for the totality of healthcare provided to dialysis patients.

CMS says this model encourages dialysis providers in the program to think beyond their traditional roles in care delivery and support beneficiaries as they provide patient-centered care that will address health needs in and out of the facility.

“This new [Accountable Care Organization] model represents a paradigm shift in care for beneficiaries with end-stage renal disease,” said Patrick Conway, M.D., MSc, acting deputy administrator and chief medical officer, CMS. “[I]t promotes a patient-centered approach to their dialysis and non-dialysis care needs that will help accomplish our delivery system reform goals of better care, smarter spending, and healthier people.”

What’s Next for the ESCO Program?

At FreseniusRx, we are pushing even further to integrate pharmacists into the full spectrum of patient care. As part of a pilot program in the Fresenius Seamless Care center in San Diego, California, I have been working directly with FreseniusRx patients and physicians chairside. This allows me the opportunity to proactively review patient medications, assess needs and coordinate with physicians as we work to improve the patient’s whole health.

The CEC Model is intended to help achieve the United States Department of Health and Human Services’ goal to have 30 percent of traditional Medicare payments paid through alternative payment models by the end of 2016 and 50 percent by the end of 2018.

In order to gather more information from a wider base of patients, CMS aims to add 7 additional ESCOs to the program in 2017, and is now reviewing applicants for the second year through competitive application process. There are currently about 17,000 patients in the ESCO programs, and CMS hopes to add 7,000 more in the second wave.

[1] Cardone KE, Bacchus S, Assimon MM, et al. Medication-related problems in CKD. Adv Chronic Kidney Dis. 2010;17(5):404-412.

[2] Rosen S, Larkin J, Thekkumkattil J, Brownlee N, Roberts S, Usvyat L, Hymes J, Ketchersid T, Maddux FW. A renal pharmacy coordinated care program is associated with improvements in bone mineral metabolism outcomes in hemodialysis patients [NKF poster abstract submission #100]. Am J Kidney Dis. 2016

[3] Roberts S, Rosen S, Thekkumkattil J, Brownlee N, Larkin J, Usvyat L, Hymes J, Ketchersid T, Maddux FW. Associations between a renal pharmacy based coordinated care program and decreased rates of hospitalizations in hemodialysis patients [NKF poster abstract submission #63]. Am J Kidney Dis. 2016.