Nearly a decade ago, a group of 10 federally qualified health centers in Minneapolis-St. Paul was competing for dollars and patients in a big way. Their relationship was “fiercely competitive,” according to a Dartmouth College study. Over the years, however, they bonded together to provide high-quality care to low-income and medically underserved populations and formed one of the nation’s first safety net Accountable Care Organizations (ACOs). These once “fierce competitors” were now “fierce collaborators,” the Dartmouth researchers noted.
For a long time, the full network lacked pharmacists and student pharmacists, although some were at individual clinics. That has changed, and it’s making a big difference in providing care. While each of the clinics had pharmacy positions, only recently did the entire network begin to include pharmacists and pharmacy residents. Their actions have gone a long way to improve their multidisciplinary framework, improve medication management and ease the burden on the physician. With the service of pharmacists, these clinics have seen major improvements in caring for patients, many of whom have comorbidities such as diabetes and hypertension.
Known as the Federally Qualified Urban Health Network (FUHN), the collaboration model includes at least eight clinics with multiple service sites. Its clinics serve about 60,000 patients, of which 27,000 are Medicaid patients. The clinics, in particular, have worked closely with the University of Minnesota College of Pharmacy, their students and their residents, said Dr. Todd Sorensen, professor and senior executive associate dean for strategic initiatives and faculty affairs at UMN. They have reported “significant improvements in quality measures when pharmacists are part of the primary care team,” he said.
Under the program, with value-based agreements with Minnesota Medicaid and the managed care plans, cost savings and additional revenue stemming from those agreements have driven the expansion of pharmacists into primary care services, Sorensen said. The network structure that manages these ACO agreements has made integration of pharmacists one of their top priorities in part because of the significant impact on quality measures they have seen, he added. The ACOs are groups of doctors, hospitals and other healthcare providers who come together voluntarily to give coordinated high-quality care to their Medicare patients, according to the Centers for Disease Control and Prevention. When an ACO succeeds in delivering high-quality care and spending healthcare dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.
Improved Care With Pharmacists’ Involvement
UMN began developing relationships with Federally Qualified Health Centers that eventually came to form FUHN two decades ago. The collaboration started with a grant from the Health Resources and Services Administration (HRSA) to establish clinical pharmacist services in three FQHCs. The collaboration has been maintained over 20 years through FQHC residency positions affiliated with UMN’s PGY1 residency program, hosting student APPEs as well as efforts to expand clinical pharmacy services to additional clinics in the network. Clinic officials have praised the collaboration and its impact on patient care, Sorensen noted. In addition, the FUHN program has had fiscal benefits through the Medicaid program, with money shared back with the project. “They are looking to expand this over time,” he said.
UMN recently received a $1.5 million Agency for Healthcare Research and Quality grant in collaboration with FUHN to implement and evaluate strategies to improve medication use in care transitions of patients who receive primary care in FUHN-affiliated FQHCs. Dr. Joel Farley is the principal investigator, leading a team of researchers and practitioners from the College of Pharmacy, UMN School of Public Health and FUHN. The effort directly targets cost savings goals established by FUHN’s value-based agreements with Minnesota Medicaid. The FQHCs are community-based healthcare providers that receive funds from the federal HRSA Health Center Program to provide primary care services to underserved areas. A strict set of requirements must be met, including fees based on ability to pay, and they must be overseen by a governing board that includes patients.