CPE Information and Disclosures Provider Status: Just Where Are We? Cdr Sylvain Grenier, Canada Forces Dr. George Jones, Defense Health Agency RADM Pam Schweitzer USPHS Cdr Sylvain Grenier, Dr. George Jones, and RADM Pam Schweitzer declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. CPE Information Learning Objectives Target Audience: Pharmacists & Technicians ACPE#: 0202-0000-16-178-L04-P/T Activity Type: Knowledge-based 1. Describe the ways that pharmacy leaders in Canada and the United States are advocating for pharmacy. 2. List how services are being documented. 3. State the impact future funding incentives and delivery models have on pharmacy practice 1. Canadian Armed Forces pharmacists have to follow the scope of practice that is regulated by: a) The Pharmacy College that has issued their licence. b) The Province in which they are currently working. c) Health Canada. d) The Canadian Armed Forces Surgeon General. 2. The DoD pharmacy enterprise is the national provider status effort. a) Not affected by b) Shaping many current initiatives around c) Exempt from any benefit of d) None of the above 1
3. Provider Status for pharmacists solves all our problems. True or False Self-assessment Question 4. To prepare for provider status, federal pharmacists can: a) improve health care delivery gaps b) learn about risk and understand pharmacists role in mitigating risk c) Ensure there is a strong credentialing and privileging program in place d) All of the above Federal vs Provincial Cdr Sylvain Grenier Canadian Forces Provincial Ministries of Health Health benefits Hospitals Professionals Health Canada Regulation of products CAF 2
CFHS Pharmacies Implementation Timeline for Expanded Pharmacy Services 1. Preparation 2. Roll-out 3. Promotion Identify reference materials Build Toolkit on SharePoint Disseminate communications to DND pharmacists Pharmacy personnel engage in self directed learning (like ADAPT training, etc.) Toolkit available on SharePoint. October 2015 Go live Policy approved Disseminate communications to all HC providers Pharmacists implement new scope of practice in their daily duties Pharmacist Awareness Month 2016 Pharmacists gain practice experience Marketing campaign to increase client awareness Start collecting performance measurements Pharmacists are proficient in providing expanded services Successes, Challenges, Next Steps Few clinics able to integrate new scope in current workflow Review of workflow and HR Workload & KPI Prescription complexity score Regulated Pharmacy Technician George Jones, PharmD, Defense Health Agency Provider Status Application for DoD Pharmacy Enterprise The Military Health System of Care Delivery Blend of Internal and External Modes Military Treatment Facilities (Internal) Active evolution of clinical pharmacy services Strength highly capable technician support Challenge high dispensing workload demand Purchased Care Relationships (External) Not recognized as Providers Lack of integrated / interoperable record systems DoD Pharmacy Enterprise - Gains From Achieving Provider Status DoD Pharmacy Enterprise - Gains From Achieving Provider Status MTF Landscape One equals One Benefit of Standardized Framework (Internal / External Application) Workflow Documentation Tri-Service Workflow Form / Process Workgroup Standardized / Universal Consistent performance measurement / Consistent acceptance Enables uniform focus on care delivery Attention On the Patient! Key Opportunity - Workflow Documentation Standardize content management Essential Documentation Framework Is Uniform Searchable Transferable Should Fully Leverage Technology Support metrics enabling value Patient guided care 3
DoD Pharmacy Enterprise Support Current Activities Expanding Clinical Services Across the Enterprise Medication Therapy Management Pilot Directed by National Defense Authorization Act Looks across multiple delivery processes Focused Patient Population Focused Services Measureable Parameters National Adoption of Provider Status illustrates this opportunity across the total delivery system Application of uniform construct to deliver care to varied populations Develop consistent expectations and measures Not dependent on payment structure - Supported by Provider Status Structure DoD Pharmacy Enterprise Make Future Seamless Patient Centered Medical Home Standardization Recognition by Internal and External Systems of Care Supports optimizing pharmacist role in care delivery Enables formation and metrics to support a uniform value framework Alignment with Supplementary Professional Pay Framework for uniform privileging expectation and criteria Enables Effort to be Focused on Care Delivery Minimizes time/effort used to overcome roadblocks to care Patient Wins! Right around the corner. RADM Pam Schweitzer U.S. Public Health Service Within the next several months - evolution of fee for service into alternative payment models fueled by MACRA and MIPS. Need to improve outcomes in order to survive financially. Providers and vendors must innovate or die Population health, big data, interoperability, telemedicine and connected health Comprehensive Primary Care Plus (CPC+) Final Regulation - Payment Models Experience with earlier models Next step in advanced primary care for both care delivery and payment design delivery changes required provide 5 comprehensive primary care functions: (1) access and continuity, (2) risk-stratified care management, (3) planned care for chronic conditions and preventive care, (4) patient and caregiver engagement, (5) comprehensiveness and coordination of care. 4
Clinician Engagement Covered MTM Programs - Medicaid Colorado Iowa Kansas Minnesota Mississippi Missouri New Mexico North Dakota Ohio Oregon Washington Wisconsin Provider designation Defining pharmacists as providers in state law Can decrease barriers to integrating pharmacists on health care teams Definitions can appear in many different areas of state code (in one state, as many as 23 definitions were found!) Where the definition is found can have an effect on the level of impact to increasing access to pharmacists services Key Points preparing for provider status Strategize on how to improve health care delivery, fill gaps. Credentialing and privileging Patient Engagement Business Process Models (Advanced practice pharmacist) New opportunities Precision medicine, Connected health Big data, population health Destiny Manage your destiny or someone else will Jack Welsh Every passion has its destiny Billy Mills 1. Canadian Armed Forces pharmacists have to follow the scope of practice that is regulated by: a) The Pharmacy College that has issued their licence. b) The Province in which they are currently working. c) Health Canada. d) The Canadian Armed Forces Surgeon General. 5
2. The DoD pharmacy enterprise is the national provider status effort. a) Not affected by b) Shaping many current initiatives around c) Exempt from any benefit of d) None of the above 3. Provider Status for pharmacists solves all our problems. True or False Self-assessment Question 4. To prepare for provider status, federal pharmacists can: a) improve health care delivery gaps b) learn about risk and understand pharmacists role in mitigating risk c) Ensure there is a strong credentialing and privileging program in place d) All of the above Closing Remarks Cdr Sylvain Grenier, Canada Forces, SYLVAIN.GRENIER2@forces.gc.ca George Jones, Defense Health Agency, george.e.jones48.civ@mail.mil RADM Pam Schweitzer USPHS, Pamela.Schweitzer@cms.hhs.gov 6