Do enhanced services pharmacies serve sicker patients?

The objective of this study was to evaluate the relationship between patients’ demographics, health status, and health resource use and attribution to a pharmacy participating in an enhanced services network. Enhanced services pharmacies were defined by participation in a North Carolina enhanced services network and an associated grant-funded payment model for enhanced services. Pharmacy enrollment in the payment model began in March of 2015. Adult, non-elderly, long-term medication users who were enrolled in Medicaid were attributed to either an enhanced services pharmacy or control pharmacy based on prescription filling patterns. Time series models were used to compare spending and resource use during the year before payment model inception. Statistical tests and standardized mean differences (SMDs) were used to compare demographics during the first 2 years of the program. The enhanced services cohort consisted of 250 pharmacies and 61,094 patients, and 2022 pharmacies and 414,860 patients served as controls. Compared with control patients, enhanced services patients used more medications and had worse health status at baseline. They were also older; more likely to be eligible for Medicaid via aged, blind, or disabled status and more likely to reside in a rural area (SMD > 0.2). In addition, enhanced services patients had greater mean baseline health care spending, hospital admissions, and emergency department visits (P < 0.001), but trends only differed for prescription drug spending (P < 0.05). Enhanced services pharmacies, as defined by this study, appear to serve a sicker population than control pharmacies. If validated in other studies, this phenomenon can, ironically, result in lower performance scores for pharmacies offering more extensive services. To correct for this, payers and measure developers should consider risk adjustment methods and quality improvement scores that account for variation in patient case mix and pharmacists’ impact on patient health over time.