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Do enhanced services pharmacies serve sicker patients?

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    Pharmacies offering enhanced services serve sicker patients, impacting performance scores. Risk adjustment is needed to accurately measure pharmacist impact on patient health outcomes.

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    Area of Science:

    • Health Services Research
    • Pharmacy Practice
    • Health Economics

    Background:

    • Enhanced services pharmacies participate in networks offering additional services.
    • A grant-funded payment model incentivizes enhanced pharmacy services.
    • Patient attribution to pharmacies is based on prescription filling patterns.

    Purpose of the Study:

    • To evaluate the relationship between patient characteristics and attribution to enhanced services pharmacies.
    • To compare health status, demographics, and resource utilization between patients of enhanced services and control pharmacies.

    Main Methods:

    • Utilized time series models to compare spending and resource use before and after program inception.
    • Employed statistical tests and standardized mean differences (SMDs) for demographic comparisons.
    • Compared 250 enhanced services pharmacies (61,094 patients) with 2022 control pharmacies (414,860 patients).

    Main Results:

    • Enhanced services patients had worse health status, used more medications, and were older than control patients.
    • Enhanced services patients were more likely to be eligible for Medicaid due to aged, blind, or disabled status and reside in rural areas.
    • While baseline healthcare spending, hospital admissions, and ED visits were higher in the enhanced services group, only prescription drug spending trends differed significantly.

    Conclusions:

    • Enhanced services pharmacies serve a sicker patient population, potentially leading to lower performance scores.
    • Risk adjustment methods are crucial for accurately assessing pharmacy performance and patient outcomes.
    • Payers and measure developers should consider patient case mix variations when evaluating pharmacists' impact on health.