Silu Zuo, Waymark’s clinical pharmacist serving patients in the greater Seattle (WA) area, can sum up the work she does in tandem with the rest of Waymark’s care team members – community health workers (CHWs), therapists, care coordinators and pharmacy technicians – in one word: empowerment.
As an example, she points to a patient who shared with a Waymark CHW that she’d been taking several supplements in conjunction with the medications her primary care physician had prescribed. After learning this, the CHW flagged that supplement for Silu who immediately realized there was a problem – one of the supplements the patient was taking had a significant drug interaction, and the patient was at risk of further organ damage given her current chronic health condition.
Silu reached out to the patient and initiated an educational conversation, explaining to the patient that the medications she was taking would interact poorly with the supplement – and was, in fact, contributing to her health risks. For Silu, this conversation wasn’t about lecturing a patient or removing the dignity of choice – it was about empowering her with the knowledge she needed to invest in her quality of life.
When many patients think about pharmacy professionals, they think of the person behind the counter at the local drugstore who checks their insurance and gives them their medications. Retail pharmacy plays a vital role in patient care, but pharmacists with the unique training and experience Silu and other Waymark pharmacy professionals have enables them take a more in-depth approach than a pharmacist in a retail setting would be able to offer.
“Pharmacists like Waymark’s are trained in the primary care and/or ambulatory clinic setting, where we see patients for chronic disease management, so we’re used to seeing the patients and having in-depth discussions about their life and how medication plays a role in that,” she said. “And, in tandem with that, we can look and see, based on what those conditions are, how other members of our care teams can empower them to better their health and be sure they’re not overwhelmed.”
Like Silu’s patient, many patients receiving Medicaid benefits struggle to understand complex medication instructions, insurance coverage details, or the importance of adherence, all of which contributes to nonadherence and medication mismanagement.
Factors like food insecurity, financial stress, unstable housing, and lack of transportation are closely linked to poor medication adherence in Medicaid populations. These social needs often outweigh medication as a priority, leading to missed doses or unfilled prescriptions.
The end of the COVID-19 continuous Medicaid coverage requirement in April 2023 led to mass disenrollment in some states, and resulted in frequent procedural denials and other interruptions in access to chronic disease medications.
Those frequent procedural denials can have lasting consequences. Our recent research, published in JAMA Network Open, found a consistent link between procedural prescription denials and an increase in both acute care utilization and healthcare spending.
Patients experiencing procedural prescription denials had a higher risk of physiologically related emergency department visits and hospitalizations compared with those without a denial. Denials in six medication classes were associated with net total medical spending increases ranging from $624 to $3,016 in additional expense per member per year.
“That’s why these clerical and procedural components are so important in conversations about medication adherence, and that’s why our model addresses those components,” said John Morgan, a primary care physician and Waymark’s VP of Clinical. “If we can immediately break down barriers to access by helping circumnavigate insurance denials or clerical errors, patients are empowered that much faster.”
The vital nature of pharmacist involvement
Not many care teams involve pharmacists and pharmacy technicians in care delivery. Healthcare professionals and administrators may not fully understand the clinical capabilities pharmacists offer, leading to low prioritization of pharmacist roles in traditional care models – and, thus, missed opportunities for meaningful collaboration.
The reality is that clinical pharmacists often have deep expertise that extends far beyond dispensing medications to include therapeutic monitoring, drug interaction assessment, disease state management, and patient education. Many see pharmacies as primarily medication-dispensing locations rather than clinical care sites, and underestimate the between-visit value to patients who need expert guidance on their medication regimen in between doctor’s visits. All of this leads to underutilization of pharmacists’ and technicians’ clinical and population health skills.
However, recent evidence shows that people enrolled in Medicaid who receive care from models that involve pharmacists and pharmacy technicians experience better outcomes than those in traditional models, where the patient’s care delivery experience is fragmented and does not involve pharmacy professionals.
A 2024 large multicenter publication found that patients receiving Medicaid receiving proactive pharmacist consultations had a 4–6% absolute increase in optimal adherence for diabetes, hypertension, and cholesterol therapy over two years, while patients in standard care saw declines. These improvements translated into projected annual healthcare cost savings of $75–$122 per patient.
“That always reminds me of my favorite quote: ‘Human behavior is the final common pathway for most advances in medicine’,” said John. “For a lot of chronic conditions, it’s about adherence to medications that don’t necessarily help a patient feel better right away, but are instrumental in ensuring they don’t experience an ADT event farther down the line. In that, pharmacists are invaluable because that’s where patients often feel the least invested.”
Ensuring patient engagement through proactive care
Waymark’s community-based care teams – including pharmacy professionals – leverage Waymark Signal™, our proprietary risk prediction platform, to identify rising risk patients. When a patient is discharged from the hospital or ED, often a Waymark pharmacist will connect with them to ensure they have what they need to get and stay well. The goal? Drive patient engagement by ensuring they understand the value of adhering to their prescribed medication regimen.
“The education is key, because patients might be misinformed or too stressed to understand what’s going on in the moment,” said Jeffrey Tingen, a Virginia-based Clinical Pharmacist for Waymark and co-author of our JAMA Network Open study. “It’s about driving patient engagement, and about making sure patients have access to us so they can understand what’s accurate. All of that means they’ll be more able to steer their own health.”
Once a patient is engaged by Waymark’s care team members, CHWs work in tandem with Waymark’s pharmacy professionals to ensure patients can access their medications and take them properly. Pharmacy technicians focus on medication access – prior authorizations, insurance coverage and access to medical devices like glucometers – and pharmacists assist patients as clinical experts and help CHWs coordinate care and communication with primary care physicians.
“We can address the common problems that cause a lot of frustration but that are easily solvable because the pharmacists and pharmacy technicians on our teams can tee them up for success,” said Jeffrey. “The work pharmacy professionals do is so important to that work. We have the bandwidth to listen to patient needs, and work with the CHWs and therapists, so we can actually close any gaps [in medication adherence] instead of just telling them to do it and then getting upset when they don’t.”
The role of pharmacy professionals in patient participation
Daisy Clay, one of Waymark’s Virginia-based pharmacy technicians, says the core mission of her role is simple: closing care gaps through patient education. Whether it’s helping a patient understand the importance of following their provider’s medication-related instructions, or explaining why a prior authorization is needed before insurance will cover a prescription or device, she works with patients and other Waymark care team members to make sure patients are empowered with the information they need to manage their health.
“When people think of a pharmacy technician, they think of it as only dispensing medicines, but when studying pharmacology, I was taught about drug interactions, different types of community based care settings, and so much more above and beyond working with insurance and dispensing medication,” said Daisy. “So even though a patient might feel intimidated by a doctor or pharmacist, we pharmacy technicians can bridge that gap and just have a conversation with them.”
Sometimes, this looks and sounds like “decoding the second language” that doctors, pharmacists and insurance companies seem to speak, added John Schimmelfing, Waymark’s Ohio-based Clinical Pharmacist Lead.
“Patients may not know how to initiate the steps they need to get what they need, but pharmacists and pharmacy techs know how to speak the language of insurance and pharmacies and take things further than patients could on their own,” he said. “A lot of times, the big box pharmacies don’t make pharmacy professionals available to patients, so it’s great that I’m able to help patients access the tools and information that make a huge difference in their health outcomes.”
As an example, a patient with diabetes who needs a glucometer often can’t meet other health-related or social goals without the assistance and care that glucometer will provide. Waymark’s pharmacy team partners with CHWs to get patients access to this tool, and from there, they can go on to achieve their other goals. If, however, a patient had to wait for a pharmacist outside of Waymark, that partnership would take much longer to create – and they would be suffering in the meantime.
They’re also able to help patients adhere to their medication plan while also ensuring they have the dignity of steering their own healthcare. Our pharmacy teams help ensure Waymark’s patients are able to access prescriptions and supplies that otherwise they wouldn’t know how to find, access and/or use. In doing this, our care teams ensure equitable, consistent medication access and adherence by breaking down the barriers to care that prior authorizations and refill issues can often cause.
“I think the secret sauce of Waymark is the peer relationship between the CHW, pharmacist, and the patient,” said Silu. “Talking to someone about their health and motivating them to take the next steps toward making their changes are better coming from a community care team member as opposed to a clinician. As a pharmacist, I get to empower the CHWs with that information and walk them through what it means to share that knowledge with the patient. And for the patient, I get to support them in investing in their health and meeting their goals.”
Ultimately, Daisy added, the presence of pharmacists and pharmacy technicians in multidisciplinary, community-based care settings supports patients as they learn to steer their own healthcare and continue working toward the best possible health outcomes.
“I think more healthcare organizations should implement pharmacy teams that are trained to educate patients the way Waymark’s teams are,” she said. “It’s not that the patient doesn’t care, because patients do care very much, it’s just that they don’t know who to go to and what questions to ask. We bridge that gap, and then help take them further.”
