The Essence of Team-Based Care in Medication-Enabled Healthcare

Updated on June 4, 2024
Two friendly pharmacists working in a drugstore.

Delivering the best medication-enabled healthcare requires sweating the details. It takes people, process, and tools.” It takes a team!

In healthcare, delivering optimal outcomes requires the delivery of evidence-based care in a personalized, patient-centric, and culturally appropriate manner. From understanding individual patients’ needs to incorporating social determinants of health, the journey to effective care is multifaceted. The heart of this process relies on a trained team of professionals, refined processes, and tools, including lots of data insights. When pharmacogenomics is brought into this mix, providers can determine which medications interact well with individual genetics, a practice that can transform healthcare and should be the standard for providing personalized medicine.

Important Factors to Delivering Patient-Centered Care

To ensure the best patient outcomes across the US healthcare system, there are three factors to consider: an aging population, cultural diversity, and social determinants. As individuals progress through the stages of life, the spectrum of health risks and chronic conditions increasingly demands a nuanced and tailored approach to care to optimize outcomes. Our diverse population (13.9% foreign-born) underscores the importance of cultural competence in healthcare delivery, particularly to ensure that care aligns with the unique backgrounds and beliefs of each patient. From access to healthcare services to housing stability and food security, these determinants play a critical role in shaping the health and well-being of aging populations. 

Healthcare providers therefore are tasked with the challenge of delivering patient-centered care that resonates with individual values and experiences. This entails going beyond the mere treatment of symptoms to consider the broader context of patients’ lives, including their cultural heritage, personal preferences, and social support systems. By recognizing the significance of these factors, healthcare providers can more effectively establish trust and rapport with their patients, fostering a collaborative and mutually beneficial relationship. 

Embracing Team-Based Care

Central to the success of personalized patient care is embracing a team-based care model that recognizes the importance of collaboration and coordination among diverse healthcare stakeholders. This collaborative approach extends beyond traditional healthcare boundaries to encompass partnerships between practitioners, pharmacists, and other members of the healthcare team. By working together, these stakeholders can leverage their unique expertise and perspectives to craft tailored medication regimens that meet the individual needs of each patient. 

Provider teams can then work together to optimize medications (called Medication Therapy Optimization or MTO) for each patient. MTO is realized by harnessing a wealth of data points to inform medication decisions, including factors such as formulary compliance, pharmacogenomics, and patient preferences. Pharmacists play a central role in this process, serving as key members of the healthcare team and providing valuable insights into MTO. Pharmacists are often the most visible point of contact for patients who go to the pharmacy on a weekly or monthly basis. By working closely with primary prescribers, pharmacists can help to identify potential drug interactions, adverse effects, and other issues that may impact patient outcomes.

Pharmacists On the Frontlines of MTO

Medications can play a crucial role in the reduction of health risks, the control of chronic disease, and the treatment of illness. However, the unintended consequences from the use of medication regimens that are not optimized for a given patient are estimated to result in hundreds of thousands of avoidable deaths and billions of dollars of avoidable spending per year. Rather than viewing medication management as a one-time event, it is important to recognize it is an ongoing process that requires regular monitoring and adjustment to ensure optimal outcomes. Pharmacists play an anchoring role in this process as well, conducting regular reviews of patients’ medication regimens and making recommendations for changes as needed. 

Increasingly, today’s pharmacist is empowered by clinical information systems that leverage up-to-date medical and pharmacy clinical rules, and incorporate member-specific insights, such as their present regimen, medical allergies, and pharmacogenomics. This enables the pharmacist to work with the prescriber(s) and the patient to implement and continually refine a regimen that positions that for the best health outcomes at the best value.

The Future of Team-Based Care

Looking ahead, team-based care and MTO are poised to advance with the adoption of artificial intelligence (AI) tools. These technological innovations promise to streamline diagnosis, reduce practitioner workload, and enhance the precision of care delivery. By automating documentation tasks and facilitating data-driven decision-making, AI holds the potential to transform healthcare delivery, ushering in a new era of efficiency and effectiveness.  For example, AI-powered algorithms can analyze vast amounts of patient data to identify patterns and trends that may not be apparent to human practitioners. By leveraging machine learning techniques, these algorithms can help to predict patient outcomes, identify high-risk individuals, and recommend personalized treatment strategies. This can significantly improve the quality of care while reducing the burden on healthcare providers.

The essence of healthcare based on MTO lies in its ability to synchronize the efforts of diverse stakeholders, processes, and tools toward a common goal: optimizing patient outcomes. By embracing practitioner – pharmacist collaboration, and leveraging data and analytics to optimize medication-enabled healthcare, we can achieve true personalized care and transform the success of our healthcare system. 

Dr. Steven Goldberg
Dr. Steven Goldberg
Senior Clinical Advisor at 

Dr. Steven Goldberg is Senior Clinical Advisor at DecisionRx.