When Channel De Leon, PharmD, BCGP, joined the Integrated Care Management Program (iCMP) four years ago as a senior pharmacist – and the program’s only pharmacist – one thing quickly became apparent to her. There wasn’t a way she could manage 3,000 medically complex patients on her own, especially given that an average iCMP patient takes 17 medications.
De Leon realized the best way to expand the breadth of the program and enhance patient care was to bring pharmacy students on board and teach them about enhancing transitions of care. In partnership with BWH Pharmacy Services, she began training students from Northeastern University and the Massachusetts College of Pharmacy and Health Sciences in 2014.
Since then, dozens of pharmacy students have completed rotations with De Leon. The students have contributed to improving medication reconciliation and adherence, helping patients save thousands in out-of-pocket costs and resolving hundreds of medical discrepancies at critical transitions of care.
For patients with complex medical conditions or multiple co-morbidities, navigating the health care system can be a challenging experience. The goal of iCMP is to help patients stay healthy through proactive care coordination and interdisciplinary support. In addition to a pharmacist, the iCMP team includes registered nurse care coordinators, social workers, community resource specialists and community health workers – all of whom work closely with a patient’s primary care physician.
“Having students as part of the program means there is more time to provide education directly to patients about their medications, and this is also a great learning experience for students before graduating,” De Leon said.
Lower Medication Expenses, Better Health
Pharmacy students on the team have a lot of face-to-face conversations with patients about medication management. Students counsel patients about their medications and assess barriers to medication adherence.
“A big factor is the cost of certain medications. We teach patients about insurance deductibles and look for resources that will help patients access the medications they need,” De Leon said.
If a patient goes home from the hospital on a new medication, the student ensures it’s affordable for the patient and, if not, works to resolve the issue prior to discharge. This process avoids gaps in treatment and unexpected out-of-pocket costs upon discharge. One student recently helped a patient save more than $10,000 in out-of-pocket costs by identifying a different insurance plan with better coverage for the patient’s specific medications.
The program is mutually beneficial to students and patients. Magie Pham, PharmD, who completed a rotation with De Leon last fall and graduated from Northeastern’s pharmacy program in May, said the skills she learned at BWH were invaluable to her training.
“While you’re in pharmacy school, you think to yourself, ‘I have to study and memorize all of these drugs,’ but communication is an equally key skill on a day-to-day basis,” Pham said. “Channel gave us guidance on everything from how to appropriately email someone to how to best communicate with patients. I never felt lost.”
Pham was among the group of pharmacy students who helped host a Medicare Part D Fair at BWH last fall. During the event, patients were paired with a student who walked them through the various Medicare D plans and identified the most affordable options based on the patient’s medication list and pharmacy preferences. By the end of the fair, students had helped patients collectively save nearly $7,000 in out-of-pocket costs.
De Leon hopes to offer the fair again this year and send students into community settings, such as senior housing complexes, which are more convenient to many patients.
Incorporating pharmacy students into iCMP has enabled the program to extend the reach of its pharmacy services, which are vital to safety and quality of care, said Lisa Wichmann, MS, RN, ACM, NC-BC, nursing director of Ambulatory Care Coordination.
“In some of our specialized programs, such as the End-Stage Renal Disease Program, Channel and her students review the medications for opportunities to reduce polypharmacy (the use of multiple drugs or more than are medically necessary) and enhance medication safety,” Wichmann said. “They’ve been able to make recommendations about simplifying the medication regime taken by some of our high-risk patients.”