Pharmacists are necessary to the medical care model

Roger Merrill, MD, chief medical officer of Perdue Foods Inc. of Salisbury, Md., told students at the University of Maryland School of Pharmacy yesterday that they should be concerned about future health care costs.

He's worried "because health care is what is putting the United States out of business on the world stage."

In delivering the Francis S. Balassone Memorial Lecture on Nov. 2, Merrill offered a Perdue perspective on the long-discussed model of "medical home" centers of care for companies and other institutions, as part of the ongoing health care reform debate.

"Medical home" is a term for a model in which patients can receive care from a primary care doctor and other medical professionals in one place, "but how it will work [in each situation] will still be discussed for a number of years to come," explained Natalie D. Eddington, PhD, dean of the School of Pharmacy.

Perdue has implemented such a model in each of its wellness programs, serving about 22,000 employees, Merrill said. But, he acknowledged, Perdue has not yet added pharmacists to the centers.

Merrill said one reason he looked forward to visiting the School of Pharmacy was to seek advice from Eddington and her faculty for adding pharmacists to each of Perdue's wellness programs.

"If you've seen one medical home, you've seen one," explained Merrill, "each case will be different."

The history of the medical home model, he said, was fueled in recent years by a number of special interests championing the Patient-Centered Primary Care Collaborative (PCPCC)--a Medicare-Medicaid Advanced Primary Care Demonstration Initiative.

Six of seven advantages to the model are an ongoing relationship with a personal physician, doctor-directed practice, whole person-oriented medicine (not organ-based medicine), coordinated care across the medical system, assured quality and safety, and enhanced access. "The United States health care system mostly fails to deliver No. 7," he said, "payment-recognized value-added services, or value of health care based on outcomes."

"No one talks about health care value per dollar spent," and they should, he said. Merrill said the medical home model is potentially effective for many medical conditions that are inexpensive to manage but have substantial benefits for both employers and patients, such as diabetes, asthma, smoking, and hypertension.

Since implementing Perdue's Health Improvement Program (HIP), health care costs for the company have nearly flat-lined, said Merrill, while national average costs per company have risen. Under HIP, all employees, except at the administrative level, fill out a health risk appraisal. HIP then provides the company with baseline data for both the company and for each employee.

He asked the pharmacy students to prepare for major changes in their profession, including expanded health care duties in various kinds of medical home models.

Pharmacists are necessary to the medical care model because "physicians are not good at medication management, pharmacists are." He said that pharmacists are also good at drug interaction, are a trusted source of health care advice, and provide appropriate value for use. They are good at medication counseling and "when progressing into disease management, you are not stepping on anyone's toes."

The lecture is held annually in honor of Francis S. Balassone (1915-1972), a distinguished pharmacy leader who collaborated with the School of Pharmacy to develop the University of Maryland professional pharmacy program.