Sometimes, a relatively modest Archstone Foundation capacity building award delivers outsized improvement in the health and well-being of older Californians and their caregivers. Such was the case with a $50,000 grant that allowed Via Care Community Health Center to bring its medication therapy management program into the lives of more than 700 low-income Latinos in East Los Angeles with multiple chronic diseases.
Older adults are the fastest growing population receiving care through California’s safety net provider system, and the number needing integrated care management because of their multiple chronic medical conditions – diabetes, heart disease and asthma among them – is also growing. Care management is a team-based, patient-centered approach that helps patients, and their support systems, manage their health more effectively. Goals of care management include improving functional health, enhancing coordination of care, eliminating duplication of services, reducing the need for expensive medical services, and increasing patient engagement in self-care.
Prescribing medication for many older adults can be challenging because of age-related changes, multiple comorbidities, language barriers, and the financial inability to buy the best medications. And so at Via Care, a full-service Federally Qualified Health Center (FQHC), the role of the clinical pharmacists has expanded beyond dispensing medication. They are becoming an integral part of the team assisting physicians and their older patients at risk of severe complications from taking too many, or the wrong combination of, medications. Clinical pharmacists work collaboratively with Via Care patients and their caregivers, primary care providers, and behavioral health providers when appropriate, to develop individualized care plans that ensure optimal, safe, and effective medication use. As a critical part of the care team, these pharmacists also conduct dosage calculations to reduce the risk of error and ensure no medications are prescribed that could make the patient worse off.
Boosting Capacity by Expanding an Evidence-Based Program
Using an Archstone Foundation capacity building grant, Via Care expanded its medication therapy management (MTM) program, an evidence-based program approved by the Centers for Medicare and Medicaid Services (CMS), to form care teams for Spanish-speaking older adults including their caregivers and a bilingual, geriatric-board-certified clinical pharmacist.
Pairing pharmacist and caregiver assures both have the same understanding of medication regimens, the same ability to identify signs and symptoms of adverse events and worsening conditions, and the same ability to identify related issues such as depression. And offering one-on-one visits with a Spanish-speaking clinical pharmacist enables older patients at Via Care to benefit from tailored assistance, medication counseling, and time to ask questions – all in their native language.
Via Care’s MTM program also deploys telehealth technology allowing virtual visits for those with mobility limitations, medication delivery to home-bound older adults (particularly the extremely ill) and making mental health assessment and referrals to Via Care therapists. To complement care management, Via Care also refers those they serve to appropriate resources for such necessities as dental and podiatric care, housing, and food.
MTM has five core elements: a medication therapy review, creating a personal medication record, a medication-related action plan, an intervention or referral, and documentation and follow-up. The goal is to optimize therapeutic outcomes as well as detect and prevent costly medication-related health problems. Critical aspects of MTM services include providing education and counseling, improving adherence to prescription specifics, and detecting adverse reactions and medication misuse.
Current evidence suggests that MTM – with the inclusion of a clinical pharmacist – improves quality of care, enhances patient health, and lowers costs for both patients and providers. Evidence also shows that implementing pharmacist-led MTM results in better prescribing patterns by physicians, reduces the number of medications taken by patients, and demonstrates improvement in most clinical and quality-of-life outcomes. Archstone Foundation’s capacity building support for Via Care meant more than 700 older Latino patients received medication therapy management for the first time. More than 600 saw improvement in their diabetes and were screened for depression – and those who needed it received access to behavioral health services.
Building Capacity
Archstone Foundation’s capacity building grants help nonprofits achieve new levels of organizational strength and effectiveness, with potential financial and operational sustainability being the key for funding consideration. The goal is to strengthen the leadership and management of nonprofits directly serving older Californians by helping bolster internal systems and finding resources to facilitate their goals. Building capacity can be accomplished in many ways: planning activities, developing board and leadership team skills, altering internal operations, making technology improvements, or developing new sources of earned income. For Via Care, adapting an already existing evidence-based program to a new audience bolstered the organization’s capacity.
Sustaining Capacity
Via Care’s grant supported a sustainable investment in the health and quality of life of its older patients. Each visit with the clinical pharmacist results in a $140 Medicare payment to the organization. More than 700 patients, each making an average of three pharmacist visits per year, has created about $290,000 in revenue – more than enough to cover the expense of the bilingual clinical pharmacist. The numbers also make a strong case for expanding the program, and so Via Care is now planning to open a new pharmacy at its South Gate clinic.
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