Pharmacists are carving out roles beyond the pharmacy counter, and Sterling Elliott, PharmD, clinical pharmacist lead for ambulatory surgery at Chicago-based Northwestern Medicine, says the shift is “essential for the future of U.S. healthcare.”
Speaking on the “Becker’s Pharmacy Leadership Podcast,” Dr. Elliott said rising health system costs and tightening reimbursement are pushing organizations to rethink how pharmacists are utilized.
“The American healthcare system is at this sort of really extensive crossroads,” he said, noting that costs continue to climb while reimbursements decline. Pharmacy, he added, has long optimized medication spend to improve margins — a capability health systems now increasingly depend on.
Dr. Elliott said this creates new urgency for pharmacists to take on leadership roles that help health systems control costs, improve outcomes and succeed under emerging value-based care models.
“There’s a huge opportunity here for pharmacists and the profession of pharmacy to make a major impact on the future of the American healthcare system,” he said.
That opportunity is especially acute in ambulatory and procedural care, where more patients are recovering at home and need support managing medications safely and effectively.
In ambulatory surgery, for example, one of the biggest determinants of patient experience and readmissions is postoperative pain. Opioids remain widely used, but Dr. Elliott said they bring well-known risks that pharmacists are uniquely equipped to address.
“There’s a real opportunity to effectively teach patients to manage their pain so we minimize their use of opioids,” he said, adding that patient-reported outcomes after surgery often hinge on pain control, and penalties for poor performance tie directly to reimbursement. “Pharmacy in general has a great opportunity to leverage that.”
At Northwestern Medicine, Dr. Elliott leads a hands-on initiative to support orthopedic surgery patients before they leave the hospital. Working with students from regional pharmacy programs, he meets patients in pre-op to set expectations about pain and explain how to use nonopioid options such as acetaminophen and NSAIDs.
They teach patients to assess pain not just on a numerical scale but through “functionality” — whether pain is affecting daily movement — and offer guidance on when opioids should be used.
“We tell them that once you know your pain never reaches the level where you’re even asking yourself those seven questions, well, you no longer have pain that comes anywhere near needing an opioid,” he said. The team also counsels patients on safe disposal methods to prevent diversion.
Surgeons have noticed the effects.
“Very often they’ll tell me about experiences they have with patients who mention that they thought it was helpful,” he said. One clinician noted that patients who embrace anti-inflammatories “have the best course of progress after surgery.”
While misconceptions about pharmacists’ capabilities have diminished inside health systems, Dr. Elliott said large external barriers remain, particularly around reimbursement. At the federal and state levels, most payers are not required to cover pharmacists’ clinical services.
“There needs to be a commitment to establish pharmacists as a viable source of patient care,” he said. Without payer motivation, he added, “they’re not going to because they just see it as a cost outlay,” despite the long-term savings pharmacists can drive by reducing hospitalizations.
To move forward, he said pharmacies must help build sustainable revenue streams tied to outcomes and also advocate for legislation that recognizes pharmacists as providers. Partnerships with physician groups, published results and philanthropic investment can all drive progress.
Ultimately, Dr. Elliott emphasized that organizations willing to support pharmacist-led innovation can unlock significant value.
“What health systems need to do is listen to these ideas, think about them, understand the value and then work effectively at finding paths forward for how to make this happen,” he said.
