Financial reimbursement of a pharmacist-led chronic care management program utilizing pharmacist extenders within a privately owned family medicine clinic.

Purpose: To evaluate the financial reimbursement of a pharmacist-led chronic care management (CCM) program utilizing student pharmacists and pharmacy residents as pharmacist extenders in a privately owned primary care practice.

Methods: A retrospective study assessing financial reimbursement of a pharmacist-led CCM program utilizing pharmacist extenders was conducted for the 12-month period from January 1 through December 31, 2022, at a privately owned family medicine practice. Return on investment (ROI) was the primary outcome. Secondary outcomes included the number of patients enrolled, number of billable patients, time spent delivering CCM (ie, "time-on-task"), and third-party claim reimbursement.

Results: During the 12-month study period, 203 patients were enrolled in the CCM program. Time-on-task was 463 hours. The number of billable patients for time-based CCM codes per month ranged from 19 to 121. Gross revenue from CCM was $55,104.64, and expenses totaled $9,482.64. Reimbursement for monthly CCM codes resulted in $44,042.31 (80%) of the gross revenue. Overall ROI was 481.1%, and ROI for monthly CCM codes alone was 364.5%. Out of the 1,046 CCM claims, 957 (92%) were paid.

Conclusion: Utilization of pharmacy residents and student pharmacists within the pharmacist-led CCM program resulted in a positive ROI, even in a small private practice. The ROI from monthly CCM codes alone was also positive, demonstrating sustainability of profits from the CCM program. Preceptors and schools of pharmacy should evaluate opportunities to utilize pharmacy learners to enhance sustainability of other pharmacist-led programs.