PHARMACY STORY

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Initial Presentation:

A 64-year-old female patient who fills her medications at Baggett Pharmacy was initially identified as eligible for the pharmacy’s appointment-based model medication synchronization (ABM) service based on the quantity of prescribed chronic medications. While conducting a comprehensive medication review (CMR), the pharmacist identified five prescribed medications for high blood pressure with several missed refills. Upon further evaluation, the patient was referred to the pharmacy’s remote patient monitoring (RPM) service due to uncontrolled high blood pressure.   

 

Select medications at baseline: 

• Four oral medications for high blood pressure 

• One transdermal patch for high blood pressure 

• Additional targets: medications for diabetes, including insulin 

 

Patient Report:

The patient reported: 

• Uncontrolled high blood pressure, Type 2 diabetes, and overweight 

• Poor adherence to clonidine patch and carvedilol 

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Physical Observation:

No notable physical observations. 

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Intervention:

Appointment-Based Model Medication Synchronization: 

• The patient was enrolled in the pharmacy’s ABM service, which includes medication reconciliation and monthly adherence calls.  

 

Remote Patient Monitoring Enrollment: 

• The patient met eligibility criteria and consented to begin RPM services for high blood pressure management. She agreed to provide blood pressure readings for a minimum of 16 calendar days each month, as is required for the program.  

• Upon providing consent, the prescribing physician was granted access to the patient’s records within the pharmacy’s RPM platform. Both pharmacist and physician have full access to patient records.  

• The patient was provided with a wireless blood pressure monitoring device that connects to the RPM platform, allowing the patient to report each blood pressure reading to the shared portal using cell phone data. The portal shows a log of blood pressure measurements taken by the patient in real-time. The device is provided free of charge to the patient by the RPM platform. The device is shipped to the pharmacy for initial setup and delivery by pharmacy staff. 

 

RPM Service Follow-Up:  

• The patient is contacted weekly by the pharmacist to discuss recent and overall blood pressure trends, and to educate on strategies to improve blood pressure, diet, and overall health. Encounters are conducted by phone and last for approximately five minutes. Each encounter is recorded in the shared RPM portal for review by the prescribing physician. Encounter length (minutes) is tracked in the RPM portal.  

 

RPM Billing: 

• The pharmacist is credentialed and contracted as a provider to bill the patient’s commercial medical insurance for RPM setup and monthly service fees. 

• RPM billing criteria include patient and prescriber consent, blood pressure readings on ≥ 16 days per calendar month, and that the provider (pharmacist) spend ≥ 20 minutes per calendar month providing disease monitoring and education.  

• If these criteria are met, the pharmacist bills a monthly RPM service fee through the patient’s commercial medical insurance. Additional time-based codes are available if more than 20 minutes of service are provided within a calendar month. 

• The pharmacy uses a medical billing service for RPM billing, but manual billing options are available.  

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Outcomes of Care Provided:

Outcome 1: Increased engagement with the healthcare team 

• The pharmacist has provided weekly RPM services to this patient for a period of six (6) months. Weekly discussions improved the patient’s engagement with her pharmacy team and awareness of her treatment plan. Related discussions and education include diet, weight management, physical activity, and how these strategies can impact overall chronic disease burden (e.g., stroke risk, diabetes progression). The pharmacist referred the patient to a dietician for further consultation outside the scope of RPM. 

 

Outcome 2: Decreased Blood Pressure and Heart rate 

• Since starting the remote patient monitoring program, the patient has been able to reduce her average blood pressure and heart rate from baseline.  

• The patient’s average vitals over six months of RPM enrollment are as follows: 

• Month 0 (Baseline): 

• Blood pressure: 151/95 mmHg 

• Heart rate: 92 bpm 

• Month 6 (Current): 

• Blood pressure: 141/92 mmHg 

• Heart rate: 83 bpm

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Outcome 3: Increased Medication Adherence  

• The patient is now adherent to her antihypertensive medication regimen and receives continued coaching during weekly discussions with the pharmacist. 

 

Outcome 4: Decreased weight 

• Since starting the remote patient monitoring program, the patient reported losing 23 pounds.  

• The patient has increased physical activity and joined a local Silver Sneakers exercise program. 

• The patient has decreased meal portion size after discussing with pharmacist and dietician.  

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Outcome 5: Decreased need for a medication 

• Since starting the remote patient monitoring program, the patient was able to reduce and ultimately discontinue fast-acting mealtime insulin. 

• The patient also switched to a Dexcom continuous glucose monitoring device to help her better track her blood glucose. 

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Outcome to the Pharmacy: 

• Under Tennessee state provider status, pharmacists may bill for services rendered under the RPM program. RPM is a sustainable non-dispensing source of pharmacy revenue.  

• The learnings and success of the RPM program has opened the opportunity for greater impact on chronic disease management, public health initiatives, and integrates the pharmacist as a key member of the patient’s interprofessional care team.