Ben Bluml’s Case for the Connected Pharmacist

Melanie Marcus: On this episode, we’re asking what becomes possible for patients when pharmacists are connected fully into the care team? A lot, as it turns out. Let’s start with two startling stats. The first one is that 90% of Americans live within 5 to 10 miles of a pharmacy. The second is that the entire U.S. population collectively passes through pharmacy doors every eight days.

What does this mean?

It means pharmacists are some of the most accessible clinicians in healthcare. The problem is that they have historically been the least connected to it, and that brings us to our guest today, Ben Bluml. Ben got his start as a hospital and health-system pharmacist in the Kansas City area, and he was an early leader in pharmacy informatics standards. 

Today, as executive director at the American Pharmacists Association Foundation, Ben heads research and innovation, designing structure and process models that enable pharmacists to deliver clinical services across care settings. Ben’s work has resulted in pathways for pharmacists to be credentialed, compensated and connected into care teams. And as we’ll hear on the episode today, this means a whole lot when it comes to patient care.

It’s great to have you on the show today, Ben.

Bluml: Well, thanks, Melanie. It’s a pleasure to be here.

Marcus: You have a clear philosophy about how care is delivered, including through pharmacists. First, I’d love to hear a little bit about your background, and we’ll get into that philosophy … but what brought you to the pharmacy world and to APhA?

Bluml: Well, I’m a pharmacist by training. While I was in high school, I had this amazing job in a community pharmacy, and what I loved about community pharmacy was the connection you had with people every day. Some of my axioms, if you will, in my practice career have really been all about doing the right thing for the patient and putting them first, empowering pharmacists as integral members of the healthcare team, and figuring out ways to integrate technology into these patient-centered, team-based care processes—and really making sure we’ve got good systems-level changes that produce the types of care delivery we know are possible when you get all the right pieces in place.

Marcus: Well, I’m excited to dive into that—putting the patient first and making pharmacists integral parts of the care team with technology and so forth. But let’s go back: You spent three decades designing ways for pharmacists to do more for patients. When you started, what was the pharmacist’s role, and how is it different today?

Bluml: I had a series of interviews for the job at APhA. I had spent about 12 years in health-system practice, and in my interview with Dr. Gans, what he was very clear about was that what APhA needed from its foundation at the time was for us to focus on producing models and evidence about the role of the pharmacist in patient-centered, team-based care.

Marcus: So, you’ve spent a lot of time doing that work, then, and I love the focus on clinical, economic and humanistic impacts. Can you talk a little about where we are right now in the pharmacist world, and how it might be different from when you started?

Bluml: The big difference today is that we’ve got the models, we’ve got a lot of evidence, and we know there are significant clinical, humanistic and economic benefits that come from integrating the pharmacist properly on the patient care team.

And ultimately, we see so many improvements—not only in the patient’s care delivery, but in their lifestyle changes and the outcomes they’re able to achieve. A lot of that depends on the condition we’re focused on. In some cases, we might be focused on hypertension, so we’re looking at blood pressure or cholesterol levels. We’re looking at lifestyle changes and other behavioral changes patients make to get the most from their medications.

Marcus: And I’m sure you have some patient stories that help put this in context. Can you tell us more about a patient whose care went off track because a pharmacist couldn’t see or wasn’t involved?

Bluml: I’ll go back to the first project I came to APhA to do. Just imagine a scenario where what we knew about patients started on lipid-lowering medications was that, essentially, the industry data at the time said only 32% to 38% of patients would still be taking those medications 24 months on.

So, what we did was implement a program where 26 community pharmacies in 12 different states cared for a little over 400 patients, using a new point-of-care testing technology from a startup out in Hayward, California, called Cholestech. The pharmacist did a finger stick to get a lipid profile, so they understood the patient’s LDL cholesterol, HDL cholesterol, triglycerides and total cholesterol.

They were able to identify people who were at risk and who might be on therapy and poorly controlled, or who might not be on lipid-lowering therapy at all. But once patients started that therapy, the challenge went back to that same problem: Most people have a hard time remaining adherent over time.

And it’s not surprising.

As a patient, how do you discover you have high cholesterol? You go to a screening event or a primary care visit. The first thing that happens is your physician asks you to change what you’re eating, to change your lifestyle, and oftentimes those changes don’t get you to your treatment goal. So, then you get started on medications.

Human behavior teaches us that a few months in, you’re doing things you don’t like—exercising, eating foods that aren’t your favorite—and those changes still didn’t get you to goal. So now you’re spending money on medications, and you still don’t feel any different than the day before you started.

So, what if your pharmacist had technology they could use in their practice to give you feedback, to help you understand how you’re progressing, how well controlled your lipid profile is, and whether you’re achieving your treatment goals so you can reduce your risk for a future cardiovascular event? Ultimately, that feedback loop with point-of-care technology helped pharmacists across the country inform patients about their progress (or sometimes lack thereof) and helped them be more compliant and persist with therapy, because they understood that changes in their medication-taking behavior, lifestyle and nutrition were actually making a difference.

One of the values the pharmacist assessed was a Framingham Risk Assessment, which helped patients understand whether their 10-year risk for a cardiovascular event was higher, lower or the same as their last visit. We had one patient who hadn’t been doing very well, even early in the program. Patients have monthly visits for the first few months, then the schedule backs off to more of a quarterly visit.

The story the pharmacist told me was that this patient hadn’t been particularly compliant with his medications, nutrition or lifestyle changes. As it happened, he’d gone to a baseball game the night before his appointment and had some ballpark franks and other foods that weren’t particularly healthy—admittedly, probably not a fasting lipid profile the next morning.

But one thing that happened that’s really telling: This patient, who even with the support of a feedback loop wasn’t adhering to his therapy, had a light-bulb moment that day in his appointment. His 10-year stroke risk had jumped two and a half times higher than at his previous quarterly visit. And he said to his pharmacist, “Wow. If I don’t make some changes, I’m not gonna be here to see my granddaughter get married.”

For that patient, it was that day when his pharmacist helped him understand that these changes are largely up to him, whether it’s nutrition, lifestyle or medication-related behaviors. These feedback loops that technology can support in community pharmacy practice can really be a game changer.

Marcus: I’m completely addicted to my health-tracking devices, and it’s the feedback, right? It’s constant feedback, and it makes complete sense that somebody on one of those lipid-lowering medications would benefit tremendously from more than annual feedback on what that medication and those lifestyle changes are doing to their health.

If you go to the pharmacy—one of the places Americans visit most—why has it historically been one of the least connected parts of the health system when it comes to providing care?

Bluml: It is ironic, isn’t it? We know from the data that 90% of Americans live within five to 10 miles of their pharmacy, so access isn’t really the problem. Another thing we know from data collected a couple of years before the pandemic is that it’s astounding: The population of the United States passes through the front doors of community pharmacies—with some duplication, sure—every eight days.

That’s an astounding number. So here we have this great access, but the paradox is that people often think of the pharmacy as only a place where they receive a product, instead of products plus the services that provide important education and safety information about the medications we put into our bodies. That’s where the real gap is.

Marcus: I don’t think I’ve received a vaccine from my doctor in years—I get them all at the pharmacy. But that data doesn’t reach my doctor unless I tell them. You’ve talked about needing data and technology to drive better outcomes. In general, what does that look like in the pharmacy?

Bluml: When we think about advanced service delivery in community pharmacy practice, we usually think of it in two categories. In the old days, when I was trained, we called one category the “hippy-dippy stuff”—health promotion and disease-prevention activities. On the other side, we’ve got health management services, which some call disease management services.

On the prevention side, just like you were talking about, you may be getting a vaccine at your local community pharmacy. You may be getting a health-risk assessment or a screening. In one of our projects, we had a group of 17 pharmacies in a community screening for bone mineral density, using heel sonogram technology. They did an amazing job putting information out to the public and helping people understand who might be at risk. When those patients came in for a screening, seven out of 10 were at high or moderate risk for a future fracture.

Marcus: I can totally see it. So, what information does a pharmacist need to do this? Like I said, with my vaccine—that’s not as big a deal, but my doctor doesn’t know unless I tell them. What information exchange needs to happen to make this possible?

Bluml: For the pharmacist to be most effective, what we consistently see is that pharmacists embedded in integrated care delivery systems—Kaiser is a great example—make a huge difference. Most of the time when I talk to physicians at Kaiser, the first thing they tell me about is the amazing contributions the pharmacist on the team makes. They don’t know how they’d deliver care without that support.

In an integrated delivery system, the pharmacist has read-write access to the patient’s entire electronic medical record. The flow of information back and forth, and the ability to contribute to that data and understand the patient’s diagnosis, condition, history and physical—all the things important to the more subtle nuances of therapeutic decision-making—are right there at their fingertips.

The majority of community pharmacies in this country aren’t so well connected, though, because they’re focused just on dispensing the prescribed medication. They don’t have access to the history and physical. They don’t have access to lab values or diagnostic results that would help inform good therapeutic decision-making.

Marcus: Well, let’s talk about what this looks like in practice. Can you talk about Project IMPACT and the IMPACT Care Transformation Network—your work with pharmacists running AFib screenings, immunizations, test-and-treat, diabetes prevention? What made those models work, and what role did data exchange play?

Bluml: This is one of the projects we just completed, so let me tell you about it. That program was implemented in 40 community pharmacies across 20 states, comprising two Medicare Administrative Contractor regions, the Noridian and Palmetto MACs. That mattered because we wanted to show that high-quality screening, identification and referral services, followed by ongoing monitoring and management, could really make a difference in people’s lives.

Let’s talk about AFib and the risk it poses, because more than 80% of people who have atrial fibrillation are walking around with it and don’t know it. And despite years of attempts at screening and identifying people who have AFib, we still haven’t found effective ways to do that.

What we hypothesized for this project—called Project IMPACT: Cardiovascular Health Plus—was: What if we got one payer to compensate the pharmacist as a member of the patient care team, just like the other members of the care team? And what if we had a sponsor who covered the cost for any patients not covered by that payer, so we could accomplish the following: What if we credentialed pharmacists just like their physician colleagues, and paid them the same, for the same CPT codes?

So, when the pharmacist screens, identifies and refers patients who have AFib, they get the same kind of payment as their physician colleague. And when that patient is referred to their primary care physician or cardiologist, whoever’s most appropriate, and gets referred back into an ongoing monitoring and management program at the community pharmacy, the pharmacist sees that patient regularly and helps them remain adherent to their therapy.

Here’s the first thing we found, Melanie, and this was really incredible: Pharmacists started with a social determinants of health (SDOH) screening. The pharmacy teams—typically the pharmacy technicians—worked with patients to understand their key social determinants beyond their medications: Do they have challenges with housing, transportation or food? Can they afford their medications? There’s a triaging that goes on with the pharmacy technician, who in some cases may even be a community health worker, connecting the patient to resources they might need.

After that first step, which helps pharmacy teams meet patients where they are, the pharmacist invites the patient to consider participating in the program, then does a stroke-risk assessment—looking at modifiable risk factors and behaviors that indicate whether a patient may be at risk. Then they use an over-the-counter device called a KardiaMobile 6L. The patient holds this device, slightly smaller than a smartphone, and 30 seconds later, the pharmacist has a medical-grade, single-lead EKG and can tell whether the patient has AFib or another abnormal rhythm.

Because pharmacies have access to the patient’s medication profile and are doing the stroke-risk assessment, they can identify patients who might benefit most from this screening. Across more than 2,100 patients, we found that pharmacists in these 40 pharmacies—credentialed and paid just like their physician colleagues—identified people with AFib at more than three times the rate expected in a normally distributed population in those geographies. That’s an absolute home run: helping people who don’t know they’re at risk discover it, get engaged in a program that helps with their lifestyle and medications, and get referred to physicians and specialists who can identify the underlying causes.

Marcus: I know you’ve spent time with the Sequoia Project and the Pharmacy Interoperability Group, and Surescripts is clearly focused on how we get pharmacists interoperable with our own QHIN [Qualified Health Information Network]. What do you think about the chicken-and-egg situation? How far can pharmacists go without this, and which needs to come first to accelerate the work?

Bluml: The solutions that tend to work are usually hybrid: both/and rather than either/or. I think pharmacists need to consider starting where they’re at: looking at their practice, their business model, what they already have a passion and clinical expertise in, and focus on that.

But they really need to get on the health information superhighway.

One of the things we’re doing in our work with different states in the Rural Health Transformation Program is setting pharmacists up with a model that lets them connect to that health information superhighway, through our collaboration with Surescripts.

Just imagine: A patient gets discharged from the hospital, and there’s a medication reconciliation issue. We have all kinds of examples where a patient is admitted on an antihypertensive medication—high blood pressure, one of a constellation of cardiometabolic challenges—that may have landed them in the hospital. The first thing that happens is a review of what medications they’re on. They find out the patient is on a single-molecular-entity antihypertensive, so the hospital ups the dose and switches them to a combination antihypertensive with two active ingredients.

They get the patient into acute care, get them tuned up, get their hypertension controlled, and put them on a formulary medication specific to that hospital. Now it’s time for discharge, and a prescription gets written for the two-ingredient medication instead of the original one. But there’s usually not a good handoff between the discharge planner and the pharmacist in the community, where the patient spends 99.9% of their lives. There’s just not good communication.

So, you don’t know—because the medications haven’t been fully reconciled from the hospital’s formulary to what’s available and covered at the community pharmacy—whether the original medication is still prescribed and present for the patient, on top of the new one. Now, instead of getting the two-product combination for their hypertension, they’re getting the original medication, plus the new one.

Say this is a Medicare patient who goes home now on three different molecular entities to treat hypertension. What happens is they become hypotensive. Their blood pressure drops, they fall, break their hip, and get admitted to the emergency room and then the hospital for a hip replacement. This is a common event, happening every day in this country, because we don’t have good coordination of care.

Marcus: All right, let’s transition to the Sequoia Project’s Pharmacy Interoperability Work Group, which brought together Surescripts, NACDS, the NCPA Foundation and the APhA Foundation. What made 2025 the right moment to bring that group together, and what’s a concrete milestone you hope it achieves?

Bluml: I think the traction that TEFCA—the Trusted Exchange Framework and Common Agreement, through the ONC—is now enjoying, with the number of CDAs being made available through the QHINs, is really important. We saw that opportunity, I believe, the way your team did and others are seeing it. We all share this belief that if we put pharmacists on the health information superhighway and make sure they’re contributing to that cause, the medication misadventures that can be eliminated or resolved are truly extraordinary.

Just starting there—not even mentioning the other models we’ve talked about—if we got the pharmacist well integrated into the team, and combined a service where they’re producing a med list, providing a cardiovascular health service like the one I described, and screening patients with prediabetes for a lifestyle-change program—where 58% to 71% of patients who complete 24 hours of group classes over 12 months don’t go on to develop type 2 diabetes—that’s an astounding number, and pharmacy technicians and pharmacy teams can do an amazing job delivering that.

What if we bundled continuous glucose monitoring (CGM) services into that, so people with diabetes get access to technology that’s life-changing, and in some cases lifesaving? If we had pharmacists plugged in through TEFCA so they could exchange data with other providers, health systems and health information exchanges in productive ways, I think—like you—we really believe we could do amazing good together.

Marcus: You’ve been at this for 30 years. What gives you the most hope right now that this moment might be different, and that we might see the pharmacist’s role evolve at scale?

Bluml: I saw a news release that ONC put out saying they’d just crossed the threshold of exchanging more than 1 billion CDAs collectively across the qualified health information networks. That gives me a lot of hope that this is a preferred future.

One of the big challenges in our healthcare delivery system: Years ago, I was talking with a technology company and asked what their vision was for how we’d interoperably exchange data among different providers and systems. They said, “Ben, that’s easy. Everyone on Earth shall use our system.” I laughed at the time, but it was frustrating, because we know that’s not going to happen.

TEFCA gives us a better path forward. It lets practitioners—whether a primary care physician, a primary care pharmacist, a nurse, someone in a health system, or someone working with population-level data at a health information exchange—move that data around and look at it in a secure, productive way. I think that’s going to help us all invent the preferred future we’re seeking.

Putting pharmacists on the team, making sure we’ve got interoperable electronic health records in our practices, and making sure that in the future, patients come away from a visit having learned more about their medications, their treatment and their progress—and have access to a portal with an EHR the pharmacist has contributed to, the same way their family physician, cardiologist and endocrinologist have—that’s what a better future looks like for our patients and for all of us as a healthcare provider team.

Because in this environment, there simply aren’t enough healthcare providers on the planet to get the job done. We’ve got to find smarter, more effective ways to work together, and there isn’t a much better way to do that than to make sure we’ve got a seamless flow of information between and among patients and every other member of the healthcare team, to make their lives better and give them a better quality of life.

Marcus: Absolutely. If every leader in healthcare could focus on one change that would better connect pharmacists to the care team, what would it be?

Bluml: I’d say make the bold choice to implement an integrated electronic health record in your community pharmacy practice.

Marcus: And it is a bold choice right now. I couldn’t agree more. We just have to make progress, right? We just have to give it a try.

Bluml: That’s right. And if you start by focusing on something pharmacists are already very comfortable and very good at—let’s get people’s medication lists right—and then evolve into all those other services, and imagine we’ve got the incentive alignments for patients, providers and payers we talked about earlier, then you can completely transform the healthcare delivery system.

Each time a patient comes into contact with any one of their healthcare professionals, we’re all working from the same song sheet, singing the same tune. We’re helping people understand, congruently, that we’re there as a team to support them in their nutritional, lifestyle, medication and treatment choices as they make decisions in their everyday lives.

Marcus: Well, you’ve given us an amazing view of what the future is, and a view of how it’s playing out today in some spaces. And I’m looking forward to it scaling over time. Let’s wrap it up. I know you’ve already touched on the better way for patients, but this is the part of the podcast where we name it: There’s a Better Way. So, what’s your better way in healthcare? What’s the ideal future for patients?

Bluml: I think the ideal future for patients is that the right legislative changes, the right payer decisions, and the right regulatory efforts in states across the country have set pharmacists up to practice at the top of their education, training and experience.

If we get that going, and we’ve got pharmacists plugged into the health information superhighway through the ONC’s Trusted Exchange Framework and Common Agreement, I think patients are suddenly going to have an app on their phone or computer—or simply a printed list—that any one of their healthcare providers on the team can give them at any visit, and we’ll all be working together in harmony to help them achieve the intended benefits and outcomes from the therapies prescribed for them.

Marcus: That sounds like a great future. This has been an amazing conversation. Thank you so much, Ben, for your time and for talking with us about the future of healthcare and the role of the pharmacist.

Bluml: Well, thank you, Melanie. I really appreciate this, and we’re excited to be on this journey together as we all endeavor to do more good for the patients we serve.

Marcus: What struck me most about my conversation with Ben is at heart a paradox.

Pharmacies are the most-visited touchpoint in the entire healthcare system, and yet, for decades, the pharmacist has been the most isolated member of the care team. They dispense medications without seeing the labs or the diagnoses, and without having the full picture of what’s going on with the patient.

Ben has spent 30 years working to change that.

The AFib screening project he described, with 40 community pharmacies and 2,100 patients, identified atrial fibrillation at more than three times the expected rate. Consider what that means at scale. More than 80% of people with AFib don’t know they have it—but the pharmacist is well positioned to identify it and tell them.

Then there’s the lipid program, and the story of a patient who hadn’t been compliant with his medications. His pharmacist ran the point-of-care lipid test, and the numbers weren’t good: his 10-year stroke risk had jumped two and a half times compared to his previous quarterly visit. And he said to his pharmacist, “If I don’t make some changes, I’m not going to be here to see my granddaughter get married.” That’s not a data point. It’s a human story. It’s patient care.

Ben’s framework—align the incentives, improve the outcomes, control the costs—sounds simple, but it isn’t. It means credentialing and reimbursing pharmacists for these kinds of services, and it means getting pharmacists fully connected into the care team. 

That last part is where I think we’re at an inflection point.

TEFCA is real. QHINs are live. What Ben’s saying is that pharmacists need to be in on this and reading from the same page, just like every other member of the care team.

And the reach to enable that is already here.

As I said at the start of this episode, 90% of Americans live within five to 10 miles of a pharmacy. Ben has shown us that there really is a better way. It turns out that it’s been five to 10 miles from home this whole time.