By Leslie Small
For a pediatric
accountable care organization (ACO) that contracts with Ohio's Medicaid managed
care plans, improving care for children would be a much more difficult job
without the expertise of pharmacists who understand the unique needs of those
patients.
"Our MCO partners
are often really well versed in the adult patient population and chronic
diseases that afflict their adult patients — but sometimes the pediatric
population's chronic conditions are different," Brigid Groves, a clinical
pharmacist specializing in population health at Columbus-based Nationwide
Children's Hospital, tells AIS Health.
Groves is one of two
pharmacists employed by Partners for Kids (PFK), the ACO affiliated with
Nationwide Children's Hospital that receives capitated payments from the
state's five MCOs to manage care for 330,000 children in central and
southeastern Ohio.
As an example of how PFK
pharmacists intervened to advocate for pediatric patients, Groves points to
when the manufacturer of one type of inhaler shifted to a new,
non-child-friendly delivery mechanism for the steroid that's dispensed by the
device.
"MCO plans were just
kind of like, 'great new product, put it on there' [their formularies]. And it
really impacted a lot of our kids because they weren't able to get their
steroid inhalers or use them appropriately," she says. But PFK's
pharmacists explained the situation, and "our plans were then able to make
appropriate changes on their formularies."
One of the MCOs that
contracts with PFK, CareSource, is currently making changes to how it covers
the immunosuppressive drug Remicade (infliximab), and "we've worked with
Partners for Kids pharmacists on our clinical criteria for prior authorization
with pediatric use of that medication," adds Nicholas Trego, Pharm.D.,
associate vice president of pharmacy for the insurer's Ohio market.
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