Two health care reform initiatives-patient-centered medical home (PCMH) and payment reform-in combination have the potential to increase clinical pharmacy involvement in patient care. However, the effects of these reforms on clinical pharmacy are highly uncertain. In particular, which clinical pharmacy services will be provided, how the services will be requested and delivered, and in what practice settings the services will be provided are not known. To gain insight into future clinical pharmacy service delivery in the PCMH, the authors examined current clinical pharmacy service delivery models at 4 sites in Massachusetts and assessed how the service delivery would change in PCMH settings with a payment approach of comprehensive payments to the PCMH. The findings suggest that (1) clinical pharmacy participation in the PCMH will increase at ambulatory care sites if supported by payment reform and (2) changes in addition to payment reform will be necessary to increase participation of community pharmacists. Needed changes are described.
Keywords: health care reform; patient centered medical home; pharmacy practice.