This projects main objective is to use the chronic care management CCM program, in a Medicare population, to maintain a pharmacist-patient clinical relationship once a patient has exhausted billable clinical hours through their Medicare benefit. As the pharmacys published outcomes have shown, patients who successfully complete Diabetes Self Management and Education DSME often require complex medication management, post education, to avoid medication-related side effects. Due to a limited number of hours that CMS allows a pharmacist to bill a patients part B benefit, many patients are not able to be seen for follow up clinical services, or this service needs to be offered free of charge by the pharmacy. While the pharmacy has utilized a previous CPF grant to help build this part of the business for patients using some commercial third party payers, a care gap that CCM could fill, still exists for Medicare eligible patients. The pharmacy has been building relationships with several large referral sources that are eligible to partner with the pharmacy to provide CCM services, along with utilizing the resources of the geographical areas Quality Improvement Organization QIO to help show the need for pharmacist inclusion in this area of patient care. Once a revenue stream is opened between the pharmacy and the primary care referral source, this project should yield a financially stable model for the pharmacy, through increased billing, the prescriber, through better CMS ratings for payment, and most importantly, better primary outcomes for the patient.
PharmD BCACP CDE
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