The Pharmacy Profession in Minnesota 2013 Marilyn K. Speedie, Ph.D., Dean University of Minnesota College of Pharmacy

The Pharmacy Profession in Minnesota 2013 Marilyn K. Speedie, Ph.D., Dean University of Minnesota College of Pharmacy

Over the past 20 years, drug therapy has become more complex: More medications per patient More complex medications available More types of prescribers Drugs purchased over the internet; mail order More physician specialists seen per patient The pharmacist is the best health care provider to manage these drug complexities.

Modern pharmacists are prepared to provide medication management to optimize health outcomes All Minnesota pharmacists who have graduated since 1996 are educated to provide direct patient care that gets desired results from medications. Medication management (or MTM) involves the identification and resolution of all drug related problems. Every $1 invested in a pharmacist = $3 to $10 savings in overall health care costs.

Pharmacy: This Is Our Time Pharmacists are well-positioned to play a major role in health reform. Pharmacists are the most accessible health care provider: 275 million Americans visit a pharmacy per week. 80% of patients receive prescriptions for at least one drug; drug therapy is the most cost-effective mode of treatment. Pharmacists have proven value and have expanded their roles on the health care team, especially in meeting primary care needs. MN is leading change as to where and how pharmacists practice and in documenting positive financial and health outcomes.

Pharmacists have many years experience with providing medication management to Minnesotans. Since 2006 Minnesota DHS has paid for medication management for Medicare patients with 2 or more chronic diseases and/or 4 or more medications. Medication management results in improved therapeutic outcomes as well as physician and patient satisfaction. Some pharmacists prescribe under the collaborative practice provision. Medication management can be performed as part of a medical home/clinic; home health (MVNA); or in a community pharmacy setting.

Pharmacists in Healthcare in MN Pharmacists are increasingly involved in transitions of care but transitions are very complicated since they often involve changes in medications and changes in the health system/ pharmacy/ physicians, etc., who are caring for the patient. Data shows a dramatic reduction of readmissions and ER visits when pharmacists are involved in transitioning care. Use of electronic records, connecting all health professionals, is growing, but is insufficient at this time to optimize use of pharmacists in the community.

Example: Pharmacists in Transitions of Care Minnesota Visiting Nurse Agency (MVNA): 30% reduction in re-hospitalizations 50% reduction in Emergency Department visits Hennepin County Medical Center (HCMC): Increased primary care visits vs. Emergency Department for high risk populations

Health care reform will dramatically affect how pharmacists practice Pharmacists are increasingly being asked to use the full scope of their strong clinical skills AND to: participate in collaborative care settings, in interprofessional teams, help lead change in the new health systems, contribute to achieving the triple aim (lower cost, better health, improved patient experience) that is the goal of health care reform, be part of pay for performance systems and use technology effectively.

Overview of College of Pharmacy Four year Doctor of Pharmacy degree program is the only program for the preparation of pharmacists (true all over the US) 640 Doctor of Pharmacy students on two campuses, Minneapolis and Duluth (both University of Minnesota campuses), connected by interactive television Extensive on-line e-learning courses for pharmacists, undergraduate students and other health professions.

What were the dimensions of the pharmacist shortage in 2000? COP and DOH surveyed rural practitioners and Twin City hospital directors Appeared to be 200 to 400 openings Caused by increase in number of prescriptions, aging population, pharmacist retirement, new roles, and too few grads New technology didn t relieve need Impact most acute in rural communities; losing pharmacist services altogether

What is the impact of a pharmacist shortage? Overworked pharmacists Increases in pharmacist salaries with accompanying mobility Limited expansion of services into medication management, even if resources available, with resultant health effects and costs Closure of rural pharmacies; loss of access to health care in rural communities Increased difficulty in finding educational sites Some improvement in professional environment as pharmacies needed to attract pharmacists

Asked whether the shortage would last long enough for justify graduating more students. Yes, prescription numbers will continue to rise Capitation bolus - graduates of large classes in 1970s will retire in 10-15 years - we haven t seen the worst of the shortage yet Can t count on surrounding states to produce more Technology is not the sole answer We were not at the national average for graduates (2/100,000 vs 3.1/100,000 average)

Expansion principles First class entered 2003 One accreditation; same basic curriculum Distance education with 20 faculty at Duluth; headed by Senior Associate Dean, Department Head, some staff, student services; 60 additional students per class (165 vs 105) Rural emphasis, aligned with Medical School Use training sites all around the state for experiential education

Class of 2016 3.52 avg. GPA 90% B.S. degree 60% female Duluth class Age range: 20-57 38% non-caucasian 8% international 66% MN resident 6% WI resident Twin Cities class

Class of 2012 81% of New Practitioners remain in MN 26%: Duluth and non-metro MN 80% of students surveyed

By 2011 the capitation bolus had been alleviated better balance of ages 30.0 25.0 20.0 25.2 20.9 21.1 23.5 15.0 10.0 9.3 5.0 0.0 20-29 30-39 40-49 50-59 > 60

1800 1600 1400 1586 1311 1326 1474 1200 1000 800 600 585 400 200 0 20-29 30-39 40-49 50-59 > 60

Remaining Workforce Issues Tremendous opportunity for pharmacists to maximize their expertise and education to provide management of chronic illness as part of collaborative team All pharmacists are not being fully utilized to the full extent of their education. The public, patients and some health professionals do not fully understand what a pharmacist can do. Medication management is not available for every eligible patient because of health plan benefit design.

Remaining Workforce Issues Likely decrease in dispensing jobs Will the shift in the role in patient care occur fast enough to keep all pharmacists employed? College will participate in workforce professional development Will continue to monitor demand

Workforce Strategies & Recommendations Include a pharmacist as an integral component of the medical/health home team. Include pharmacists as accountable providers in Accountable Care Organizations; compensate for role in improving health outcomes. Utilize pharmacy technicians as a cost effective way to distribute product.

Desired Outcomes Lowered total health care costs for chronic illness. Better outcomes for patients. Improved health for chronically ill Prevention of illness (immunizations, etc.) Improved patient satisfaction. Other team members can spend their time on what they do best. Help fill the primary care gap.

Curriculum revision for Fall 2013 It is designed to produce pharmacists who are outstanding clinicians with a strong scientific foundation, but who can participate in collaborative care settings, help lead change in the new health systems, contribute to achieving the triple aim (lower cost, better health, improved patient experience) that is the goal of US health care reform, and use technology effectively. New curriculum had a Fall 2013 start; will be rolled out over four years.

Curriculum revision It begins with Becoming a Pharmacist and ends with Being a Pharmacist aimed at developing professionalism and an understanding of the context of healthcare and the patient experience early in the curriculum and then focusing again on health systems and professionalism as they experience it in the fourth year. Integrated curriculum with active learning. Competency domains: 1. patient-centered care 2. population health and vulnerable communities 3. health systems management 4. leadership and engagement 5. professional and interprofessional development 6. scientific inquiry and scholarly thinking

College of Pharmacy-run MTM Network Expansion of UPlan Medication Therapy Management (MTM) Network: 2009: Added MTM benefit to UPlan per evidence of patient benefit. CoP: developed network of pharmacies & pharmacists across MN to serve U employees administers MTM benefit: recruiting & credentialing sites, CQI, marketing, reviews The State of MN engaged the network in June 2013 to provide medication management to diabetics. Currently other customers would like to contract with UPlan network for MTM and other pharmacy services. As contracts are implemented, we ll spin off network management as separate 501(c)(3) with collegiate oversight.