Contributed by Blair Thielemier, PharmD, Pharmacy Customer Success, PQS by Innovaccer

Pharmacists have always known where the gaps are.

They solve medication-related problems every day in the dispensing workflow. They identify gaps in therapy and assist in navigating multiple providers for each patient. They know their patients well enough to recognize when someone is confused, overwhelmed, nonadherent, undertreated, overtreated, or at risk of falling through the cracks of a fragmented healthcare system.

As pharmacist-led services continue to evolve, especially in community-based, ambulatory clinics and value-based care models, merely seeing the problem is no longer enough. Building pharmacy practice models that support integrated, whole-person care as part of the healthcare system, not separate from, is the ultimate goal.

For pharmacist-led services to become sustainable, scalable, and respected by other providers, they must be able to answer a bigger question: What value does this service create?

Since the genesis of the profession, pharmacists have been excellent at recognizing patients’ needs but have not necessarily formally tracked them as part of daily practice. 

A pharmacy reports how many prescription “fills” it completes in a day, how many MTMs a month, number of immunizations given, etc. but not clinical interventions, which need to be documented in order to be qualified as reimbursement opportunities.

Clinical opportunity documentation matters for reimbursement because it creates a trackable outcome.

A pharmacy service that is clinically meaningful, but operationally inefficient, will not survive in the fast-paced, dispensing-centric model of community pharmacy. 

However, a pharmacy service that produces a trackable outcome, can be integrated in payer models, thereby moving innovative pharmacy programs beyond the pilot stage and creating an opportunity for documenting pharmacist-led interventions.

To build integrated pharmacy services that last, there are three categories to track: clinical impact, operational efficiency, and financial sustainability.

1. Clinical impact: Did the service improve patient care?

This is where pharmacists are trained to begin, with the evidence.

Clinical impact tells the story of how a pharmacist-led intervention generates a meaningful shift for the patient. Depending on the service, this may correlate with controlled blood pressure, A1c reduction, medication adherence check-ins, proportion of days covered (PDC) rates, immunization gaps, therapy optimization, deprescribing, care gap closure, reduction in medication-related problems, and successful medication reconciliation following transitions of care.

These outcomes matter because they directly connect the pharmacy service to patient health and show up in the evidence. Patients treated in pharmacist-physician collaborative care models were 3 to 5 times more likely to reach A1c control than those in standard care models.

Clinical impact should be specific and well-documented for each patient intervention. A pharmacy service that “helps patients with diabetes” is not as powerful as evidence that shows “X number of patients enrolled in diabetic support programs improved medication adherence by a percentage, recorded follow-up dates, measurable progress in A1c reduction, and decrease in insulin use.”

The more clearly these data points define and measure quality indicators, the easier it becomes to design the service around that outcome and make improvements.

This also helps shift the conversation from “pharmacists are accessible” to “pharmacists are accessible and measurable members of the care team.”

2. Operational efficiency: Can the service fit into real workflow?

This category is often overlooked because documentation has not been a part of the traditional pharmacy practice model in community pharmacy.

A program can be both needed and clinically relevant yet completely unsustainable under the pressures of real-world practice. The central question is whether the service can work inside the daily rhythms of a pharmacy.

New clinical services cannot keep being layered on top of overwhelmed teams and expect them to be adopted simply because the mission matters. Pharmacists and pharmacy technicians are already carrying a significant workload with limited resources. 

When researchers interviewed community pharmacy owners and managers for a 2025 implementation study, willingness was never the constraint. Pharmacists wanted to deliver patient care services, but uptake stayed inconsistent without implementation support and a clear reimbursement structure behind it.

The clinical workflow has to be designed to align with the priorities of community pharmacists. 

• Who identifies the patient? 
• Who documents the intervention? 
• Who follows up? 
• What happens if the patient does not answer? 
• What technology is required? 
• What can be delegated to a technician? 
• What must be done by the pharmacist?

These are not minor details. They are the difference between a service that looks good in theory and a service that actually becomes part of standard pharmacy practice.

Pharmacists are not lacking passion, especially community pharmacists. They often lack the operational infrastructure required to make clinical care sustainable.

Thinking operationally shows where the model is strong, where the team is strained, where documentation breaks down, and where technology can support the work.

Clinical services do not become scalable because the team cares more. They become scalable when the structure exists to support the care.

3. Financial sustainability: Can the service support itself?

Financial sustainability does not mean putting profit ahead of patient care or sacrificing revenue potential for a change in process.

It means acknowledging that meaningful clinical services require resources, such as time, training, staffing, documentation, technology, leadership, and follow-up. It also requires a structure that allows pharmacist providers to be paid for clinical services like any other non-physician provider.

A 2025 sustainability analysis in the Journal of the American Pharmacists Association modeled a blended service of preventive and collaborative visits and projected $286,700 in annual revenue against a net surplus of $105,500, a return of roughly 1.58 to 1.

Depending on the model, financial metrics may include revenue per encounter, reimbursement rate, patient-pay conversion rate, cost per appointment, staff time cost, referral volume, repeat visit rate, payer contract potential, employer contract value, or renewal rate.

In a pharmacy-based program, the financial question is whether the service creates enough value to justify the workflow investment.  Financial sustainability is not separate from clinical care. It is what allows clinical programs to grow and flourish.

The future of pharmacy practice needs both vision and structure.

Bringing the three numbers together

The future of pharmacy services relies on the integration of clinical impact, operational efficiency, and financial sustainability.

If a service improves patient care, fits in the dispensing workflow, and is financially self-sustaining, it has scalable potential.

Keeping track of these three categories manually requires precious resources, making a practical case for autonomous healthcare operations technologies. When clinical, operational, and financial data are connected digitally, the value of the work becomes tangible and replicable.

This creates leverage as pharmacists continue to expand their roles in value-based care, population health, chronic disease management, transitions of care, preventive wellness, collaborative practice and integrated whole-person care.

Healthcare does not need pharmacists to play small. It needs pharmacists to solve big patient problems, document the value of their interactions, and build clinical pharmacy models that work within their existing workflow.

That begins with community pharmacies having the operational business layer for clinical services. With the right technology and program design, the profession can demonstrate how medication-related problems get solved using intelligent technology.