INNOVATIONS in pharmacy

Pharmacist-Physician Split-Shared Visits in a Federally Qualified Health Center: Lessons Learned from a Novel Reimbursement Model using Telehealth

Nada M. Abou-Karam

Western University of Health Sciences College of Pharmacy

Melisssa E. Jump

AltaMed Medical Group

Jingying Jiao

West Coast University School of Pharmacy

Andrew N. Schmelz

Butler University College of Pharmacy and Health Sciences

DOI: https://doi.org/10.24926/iip.v13i1.4451

Keywords: shared visits, split visits, split-shared visits, pharmacist-physician collaboration, reimbursement models, telehealth

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Abstract

Introduction: The Federally Qualified Health Center (FQHC) setting poses unique challenges to reimbursement of services provided by ambulatory care pharmacists; however, recent changes to telemedicine reimbursement have created new opportunities to help overcome these challenges. This article describes the experience and outcomes of the implementation of a novel, pharmacist-physician split-shared telehealth model at AltaMed Medical Group, a large, multi-site FQHC in Los Angeles and Orange counties. 

Program Development and Implementation: A pilot program for pharmacist-physician split shared tele-visits was launched at one clinic site with one clinical pharmacist and has since been expanded to a total of 6 sites and 5 clinical pharmacists. Prior to this program, clinical pharmacists saw patients for diabetes mellitus (DM) video-conference disease management appointments. With the launch of the pilot program, additional steps were added to pre-existing workflows to create a model in which visits with the clinical pharmacists were followed by an “enhanced visit” with an eligible, billable clinic provider.

Outcomes: Average A1c change for all patients in the split-shared model was -1.5%, and average A1c change for program graduates from enrollment through graduation was -3.8%. Evidence from similar services have also been associated with significant increases in revenue from a split-shared model, indicating this design can be a viable option for financial justification of ambulatory care pharmacy services.

Conclusion: In the setting of current limitations, we advocate for increased utilization of shared visits and split-shared visits as a viable method to generate revenue and aid in the justification of clinical pharmacy services.