Spotlighting clinical practice partners: Mill City Clinic

Dr. Kylee Funk in front of the entry to Mill City Clinic. 

One of several clinical practice collaborations the University of Minnesota College of Pharmacy has with the University of Minnesota Physicians is Mill City Clinic located in downtown Minneapolis. The clinic provides care for patients from hundreds of zip codes. Dr. Jon Hallberg, a family medicine physician and professor in the Department of Family Medicine and Community Health at the University of Minnesota Medical School, opened Mill City Clinic in 2008 with a nurse practitioner and a physician assistant by his side. Now, several physicians, a dietician, a behavioral health clinician and a pharmacist power its health care team.

Mill City isn’t the first clinical partner to integrate a pharmacist onto its health care team, but it was created with that idea in mind, Hallberg said. In the early 2000s, the College of Pharmacy suggested exploring medication therapy management and embedding a pharmacist in the clinic— a concept that was revolutionary at the time. For the last several years, Dr. Kylee Funk, professor in the Department of Pharmaceutical Care & Health Systems, has provided medication therapy management and diabetes expertise at Mill City. 

“I feel very safe asking the physicians and team members questions and I think they feel the same way… we rely on each other to provide the best care for the patients,” Funk said. “I look at things through a different lens, so I think I've been able to uncover things like rare side effects patients have had from their medications and help them find the path forward.”

Mill City is inherently interprofessional, which is a key factor in its successful patient care, Hallberg said. Physicians have a lot of ground to cover with patients in an appointment and generally don’t have the time to go through an individual's medication list with a “fine-tooth comb” the way an integrated pharmacist can. Funk’s role as an instructor at the college gives her a helpful edge, keeping her up to date on the most current medications. 

“Many older folks are over-medicated, have conflicting medications, or medications with truly bad side effects… to have Kylee sit down and review their medications has been so helpful,” Hallberg said. “It saves money, it reduces harm, side effects, drug interactions, unnecessary duplication— it sort of sells itself.”

Funk’s presence at the clinic is not lost on patients, Hallberg said. They recognize the value of what she provides, the same way they do with the clinic’s dietitian and mental health specialist. A physician shared with her that one patient in particular was moved to tears by how much Funk was able to improve his diabetes management. The patient had been reluctant to divert from his previous treatment path, but decided to shift strategies after discussing his medication options in depth with Funk. 

“You're trying to get the best match for the person in front of you... In that conversation, it just kind of clicked with the patient— I think I had the time and knowledge to answer some of his questions about the medications in detail,” Funk said. “Some of his side effects with the previous treatment went away and then he just had a ton of success… After we worked together for about a year, he was at goal and I discharged him from my practice.”

She also shares her knowledge on prescription drug plans, deductibles, coinsurance and the like with patients to help them find the most cost-effective treatment for their needs. Particularly under the umbrella of diabetes care and weight management, for which many of her patients come in, the medication options change rapidly, as do the cost considerations. 

“We can keep prescribing medications, but if patients can't afford them to take them, then nothing else matters,” Funk said. “If they can find a more affordable medication that’s just as beneficial… then they can use that money on a gym membership, better food, visiting their family— things that are good for their health.”

Not only does Funk’s role improve patient care, but it also helps her team members. Hallberg said her contributions to the clinic lessen the burden on triage nurses, who already have a heavy workload. Where a triage nurse can’t sacrifice the time to help a patient find more affordable versions of their medications, an integrated pharmacist like Funk can. 

“We actually have a very small percentage of her total work time, but it doesn't feel like that to our patients,” said Priscilla O'Neill, the clinic nurse manager at Mill City. “Even though we may only have Kylee one day a week in total, she makes it feel like she's available— that's what integrative care is. Our patients get all the care they need, all the time, and we make that as seamless as we can.”

Funk has even conducted a study showing that many aspects of clinicians’ work lives were improved by adding a pharmacist to their team. 

“We found that a pharmacist providing comprehensive medication management provides both a collaborative partner and an added skill set, leading to primary care clinician outcomes like decreased workload, satisfaction that patients are receiving better care, decreased mental exhaustion, and enhanced professional learning— and this goes both ways, because I learn so much and benefit from my collaboration with the physicians,” Funk said.