Ambulatory Pharmacy in Action: House Calls and Harm Reduction Clinics Expand the Reach of Care

At the 2025 American Society of Health-System Pharmacists (ASHP) Pharmacy Futures meeting, several forward-thinking ambulatory pharmacy models took center stage—1 bringing care into the homes of medically and socially complex patients across the Mountain West, the other tackling substance use disorders in a walk-in clinic in northeast Ohio. Amy Stokes, PharmD, of Intermountain Health, and Amanda M. Benedetti, PharmD, of MetroHealth, showcased how ambulatory pharmacists are redefining patient access, clinical collaboration, and cost avoidance in innovative ways.

Bringing Pharmacy to the Patient: Intermountain House Calls

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In Utah and surrounding states, Intermountain Health has launched Intermountain House Calls, a program that brings primary care to patients who cannot get to traditional clinics due to medical or social complexities.

“Patients often have challenges getting out of their homes,” Stokes explained. “This program is designed to go to the patient.”

Serving 4 regions in Utah, the program aims to reduce avoidable utilization by supporting high-risk patients with either a value-based contract or no insurance. The focus is on those with multiple comorbidities, frequent readmissions, or social barriers like post-hospitalization isolation.

The multidisciplinary team includes advanced practice providers, care managers (nurses and social workers), and mobile services such as labs and home health. Pharmacy services are provided remotely and include support from both pharmacists and pharmacy technicians.

“When our program first started, it only had a pharmacist,” Stokes said. “We discovered that including a technician was critical to help our pharmacist do clinical work.”

Technicians now lead pharmacy huddles, coordinate medication histories and home delivery, and work alongside care managers to ensure comprehensive medication reviews (CMRs) are completed before a provider sees the patient. This collaboration has allowed pharmacists to focus on clinical problem-solving—assessing indication, safety, and adherence, and developing care plans.

In 2024 alone, the program completed 1062 pharmacist encounters (including 449 CMRs) and 1154 technician-led patient encounters. It identified 2805 medication therapy problems, including issues with therapy optimization (35%), monitoring (14%), and health literacy (12%), among others. Pharmacist interventions led to an estimated $580,008 in cost avoidance, including $1292 saved per completed CMR.

Technicians and pharmacists log their interventions in the electronic medical record to capture the program’s impact across the broader health system. Despite underreporting (Stokes estimated 56% of therapy problems go unreported due to software limitations), the program has achieved impressive outcomes: a 32% increase in referrals, 37% more patient enrollments, a 27% drop in emergency department visits, and a 99% hierarchical condition categories capture rate.

Meeting Patients Where They Are: MetroHealth’s Harm Reduction Model

Across the country in northeast Ohio, Benedetti shared how MetroHealth’s motivation and engagement clinic (MEC) is addressing substance use disorders through a low-threshold, walk-in harm reduction model. Originally designed for short-term stabilization, the clinic now sees sustained growth, with visits rising from 1919 in 2021 to 8488 in 2024.

Transportation barriers were tackled through partnerships that provide Lyft rides, bus passes, and food bank collaborations.

“A lot of the patients attending had difficulties with transportation,” Benedetti said. “So we were able to develop relationships to help them get to and from the clinic.”

Pharmacist involvement began in February 2024, after Ohio removed the X waiver and allowed pharmacists to register as mid-level practitioners with Drug Enforcement Agency (DEA) authority. Benedetti now sees patients 2 full days per week and prescribes under a collaborative practice agreement (CPA) that covers medications for alcohol and substance use disorders, such as buprenorphine, naltrexone, and acamprosate, along with supportive therapies like hydroxyzine and ondansetron.

“The first step to the pharmacist being able to prescribe in the clinic was developing a CPA,” Benedetti explained. “The goal was to provide a consistent, systematic, evidence-based, and multidisciplinary approach to the ambulatory care of patients with alcohol use disorder and/or opioid use disorder, and also to achieve desired treatment goals while maximizing prescribing provider time, reducing disease burden, and improving quality of life while reducing health care costs.”

Under the CPA, pharmacists must follow national guidelines from the American Society of Addiction Medicine, the Providers Clinical Support System, and the Substance Abuse and Mental Health Services Administration. Benedetti shared that her DEA registration was approved quickly, although state licensure took longer.

MetroHealth’s pharmacists bill based on time, with an average reimbursement of $23.50 per visit. Although this only covers about 10% of the billed amount, Benedetti emphasized the broader value pharmacists bring: “It would take a lot of visits to compensate a pharmacist’s salary, but we have to consider those hidden benefits and costs.”

Despite some limitations—such as restricted ability to see new patients or initiate certain prescriptions—MetroHealth’s model has improved medication access, reconciliation, and job satisfaction among pharmacists. The clinic is now considering expanding to a third day per week to meet patient demand.

“As pharmacists, our focus is really on medications,” Benedetti said. “So just being able, when I’m seeing a patient, to go over their medication list and clean it up—it helps every provider they see afterward.”

Conclusion

These 2 models—1 home-based, the other community-based—demonstrate how ambulatory care pharmacists are carving out essential roles in nontraditional care settings. Whether tackling chronic disease at home or substance use in the community, they are bridging care gaps and transforming the reach and relevance of pharmacy practice.

REFERENCE

Benedetti AM, Stokes A. Revolutionizing Ambulatory Care: Exploring Innovative Practice Areas. Presented at: American Society of Health-System Pharmacists Pharmacy Futures 2025. June 8, 2025. Accessed June 8, 2025.