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Why We Need to Stop Worrying About Who Is and Who Is Not Paying for Long Term Care at Home

In the ever-evolving landscape of healthcare, the question of who pays for what can often be a source of uncertainty and concern. But what if I told you that there's an opportunity right now—one of the most significant opportunities in pharmacy's history—and it's time to stop worrying about who's footing the bill for Long Term Care at Home (LTC@H)?

The Untapped Potential of Long Term Care at Home:

Long Term Care at Home is not a fleeting trend; it's a transformative model of care that's here to stay. It represents one of the fastest-growing patient populations the pharmacy industry has ever seen. While not every payer or Pharmacy Benefit Manager (PBM) has formally recognized LTC@H and paid for it at the same reimbursement rates as traditional long-term care, make no mistake—they all know it exists, and they are actively seeking ways to support and integrate it into their payment structures.

Why Pharmacy Needs to Get on Board Now:

The urgency lies in understanding that if pharmacies don't embrace LTC@H now, they risk missing the bus altogether. This isn't a matter of just getting involved once the payment mechanisms are firmly established. By then, the opportunity may have passed, and pharmacies will find themselves playing catch-up in a crowded field.

For too long, pharmacy has been promised better reimbursements, provider status, and payment for clinical offerings. Long Term Care at Home isn't a distant hope or an elusive dream—it's a tangible, real segment of healthcare with a growing patient population. It represents one of the most promising and accessible opportunities in pharmacy right now.

The LTC@Home Revolution:

So, why is LTC@H such a game-changer for the pharmacy industry?

Growing Patient Base: The aging population is rapidly expanding, and more individuals are seeking care within the comfort of their homes. This translates to a larger pool of patients who could benefit from LTC@H services.

Holistic Care: LTC@H is not solely about medications; it encompasses a comprehensive approach to patient care, including medication management, disease-state management, lifestyle support, and emotional well-being. Pharmacists can play a pivotal role in delivering this holistic care. All of those clinical and value-based services that traditional community pharmacy doesn't have the time for, falls into place in @Home models.

Cost-Efficiency: For payers and healthcare systems, LTC@H represents a cost-effective alternative to institutional care. By getting involved now, pharmacies can demonstrate their value and secure their place in this evolving model of care.

Patient-Centric Focus: LTC@H places the patient at the center of care, aligning perfectly with the philosophy of community pharmacy care. It allows pharmacists to establish deeper connections with patients and make a meaningful impact on their lives.

Pioneering Innovation: The LTC@H model is ripe for innovation. Pharmacists have the opportunity to develop new services, technologies, and solutions that cater to this growing patient population's unique needs.

A Call to Action:

The time for action is now. Pharmacists and pharmacies must recognize that LTC@H is not a distant concept—it's the present reality and the future of healthcare delivery. Those who embrace it early will reap the rewards of being pioneers in this transformative space.

Don't let concerns about who's paying for LTC@H hold you back. Don't wait for 'everybody' to start paying for it before you jump in. Instead, trust the pharmacy owners who have tirelessly championed this model, even without additional reimbursement rates, for years. They've not only made it sustainable but profitable, all while demonstrating to payers that it's a legitimate sector of pharmacy that deserves proper compensation. Focus on the immense potential it offers. Engage with payers, collaborate with other healthcare providers, and explore innovative ways to deliver exceptional value to patients in their homes.

The LTC@H revolution is happening right now, and pharmacies have a golden opportunity to be at the forefront of this transformative shift in healthcare. Stop worrying about who's paying for LTC@H and start positioning yourself to be a leader in this thriving segment. The future of pharmacy is knocking, and it's time to answer the call.

Written by Lindsay Dymowski Constantino, President & Cofounder, LTC@Home Pharmacy Network

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