Key factors for sustainable integration of pharmacists in team-based primary care physician practices.

Objectives: To (1) identify strategies for financial justification of pharmacists integrated into team-based primary care, (2) describe the payment models currently used for integration of pharmacists into team-based primary care, and (3) elicit key factors facilitating sustainable pharmacist-provided patient care services in the primary care setting.

Design: Qualitative analysis using semistructured interviews.

Setting: Nonacademic outpatient primary care physician practices throughout the United States from January to April 2014.

Participants: Pharmacists responsible for leadership of clinical pharmacists in primary care practices whose positions are supported through nondispensing patient care services.

Main Outcome Measures: Current payment model, infrastructure, documentation strategies, and methods of quality assessment.

Results: Twelve interviews were conducted. Practices included a combination of single- and mixed-payer models in integrated and nonintegrated health systems. Various billing strategies were used, particularly in nonintegrated models, to sustain pharmacists in primary care practices utilizing both fee-for-service (FFS) and value-based incentives payments. Five main themes were elicited: (1) Pharmacists are integrated and valuable members of health care teams; (2) pharmacists are documenting in an accessible electronic health record; (3) data tracking is a facilitator for justifying and adapting practice; (4) systematized processes for pharmacist integration exist in each practice; and (5) pharmacists' responsibilities on the team have grown and evolved over time.

Conclusion: Pharmacists' contributions to improving patients' medication-related care are the same regardless of payment model. Financially sustainable integration of pharmacists on the team involves using a combination of FFS and value-based incentive payments, consistent documentation, meaningful collection of pharmacists' contributions to improve the quality of care, and a firm understanding of the practice's needs and financial structure. These themes can be used as a guide for pharmacists as they establish themselves in an FFS environment and adapt to a future in value-based care.