Transcript Expanding the Role of the Pharmacist

Expanding the Role of the Pharmacist
Enhancing Performance in Primary Care
through Implementation of
Comprehensive Medication Management
Barriers/challenges faced
• Limited understanding of the medication management intervention
itself (i.e., unclear to many what it is and how one would deliver it)
• Limited targeting of patients most in need
• Wide variability and inconsistency in implementation across care
settings
• Wide variability in outcomes
• Limited reimbursement to support such services in primary care
New value-based payment models hold promise, but we must define
what this is and show impact
The Opportunity
• Strategies to address the safe, effective, and affordable use
of medications in primary care are critical to enhance care
transitions, improve health, and control costs;
• CMM holds promise as an effective, value-added strategy to
optimize medication use;
• However, several questions must be addressed to advance
CMM implementation and ensure its widespread uptake and
sustainability in primary care medical practices.
Research Funding Announcement
American College of Clinical Pharmacy
• What exactly is the intervention
and how can we ensure it is
replicated and scaled?
• How is the clinical pharmacist
integrated into the practice to
ensure efficiencies and impact?
• Which patients and populations
would benefit the most from
CMM?
• What is the return on investment
of having the clinical pharmacist
embedded in the office or clinic?
• Among those who receive CMM,
what is the impact on quality of
care and cost?
• How do we disseminate learnings
and ensure scale and
sustainability?
Enhancing Performance in Primary Care
through Implementation of Comprehensive
Medication Management
Study Leads
Todd Sorensen, PharmD
Mary Roth McClurg, PharmD, MHS
Co-Principal Investigator
Principal Investigator
University of MinnesotaUNC Eshelman School of Pharmacy
College of Pharmacy
University of North Carolina at
Alliance for Integrated Medication
Chapel Hill
Management (AIMM)
Jennifer Carroll, MD, MPH
Co-Principal Investigator
American Academy of Family
Physicians-National Research
Network
CMM in Primary Care
University of Minnesota-College of
Pharmacy
CMM Grant Steering
Committee
Payer Advisory Group
Center for
Medication
Optimization
through
Practice and
Policy
UNC Eshelman
School of
Pharmacy
American Academy of Family
Physicians National Research
Network (AAFP-NRN)
National Implementation Research
Network
Alliance for Integrated Medication
Management
Minnesota Cohort
(n=23)
North Carolina Cohort
(n=10)
AAFP-NRN Cohort
(MN, NM, NY, OH)
(n=10)
Hybrid Implementation-Effectiveness Design
Stage 1: Establishing Shared Philosophy and Decision to Invest and Adopt
Aim 1: Baseline Assessment; Readiness and Capacity to Change
Stage 2: Establishing the Patient Care
Process
Stage 3: Building the Practice Management
System to Support CMM
Aim 2: Best Practices in Design & Delivery of CMM
Aim 3: System-level and Structural Elements to
Support Effective & Efficient Delivery of CMM
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Collect patient information
Assess the patient and their medication-related needs
Develop and document the care plan
Implement the care plan
Provide follow-up
Pharmacist-provider communications
Pharmacist-patient communications
Standards and systems for documentation of patient
encounters in the EMR
Triage and care coordination processes
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Practitioner credentialing
Predictive analytics/patient risk stratification
Data integration systems supporting evaluation of return
on investment and value
Quality measurement and reporting within the practice
Quality assurance and continuous practitioner
development programs
Tools to support practitioner & practice efficiency
Payer relations, billing & data exchange systems
Stage 4: Demonstrating the Value of CMM toward Achieving the Triple AIM
Aim 4: Key Performance Measures and Effectiveness
Improved Health
(Clinical & Operational Measures)
Improved Patient & Provider
Experience (Satisfaction Measures)
Lower Per Capita Cost
(Return on Investment to the Practice)
Stage 5: Scaling and Sustaining CMM
Aim 5: Accelerating Spread and Adoption of CMM in Primary Care
Actual or expected results/outcomes
• Identify and articulate a consistent approach to delivering
comprehensive medication management
• Identify best practices in delivery of CMM
• Identify strategies for integrating these services within the overall
infrastructure and operations of the primary care practice
• Evaluate the impact of the intervention on important metrics of care,
including total cost of care, health services utilization, quality metrics,
and medication-related problems.
• Build the business case
• Disseminate findings to ensure widespread uptake, scale, and
sustainability
The Intervention
Comprehensive Medication Management
CMM Patient Care Process
Active Implementation
Usable Innovations
• EFFECTIVE & USABLE INNOVATIONS
– What exactly are people saying and doing that makes things
better for our intended beneficiaries?
• STAGES
– What steps lead to successful implementation?
• DRIVERS
– What critical supports are needed to make this change? What
is the infrastructure?
• TEAMS
– Who takes responsibility for and helps guide the change
process?
• IMPROVEMENT CYCLES
– How can we create more hospitable environments, efficiently
solve problems and get better?
Stages
Drivers
Teams
Cycles
National Implementation Research Network
Aim statement: To build capacity of organizations to use evidence based implementation
practices to support the effective and sustained use of innovations and produce outcomes.
Usable Innovation*:
Comprehensive
Medication Management
Team
development*
Fidelity
Assessment
Clear
Description
Operational
Definitions
Essential
Functions
Patient care
process
assessment:
DTPs not formally
classified
Practice
management
assessment:
DTPs not formally
documented
CMM Fidelity
Competency Drivers
Organization Drivers
Leadership
Full
Implementation
defined as, 50%
of patients at
need of CMM
services are
receiving CMM
with fidelity and
with the intended
outcomes.
Aim 4: Focused on Formal Evaluation
Year 2
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Total cost of care / return on investment
Health services utilization
Quality metrics
Drug therapy problems
Patient and provider perceived
value/satisfaction
• Other
Financing/regulatory changes needed
to implement more widely
Integration of medication optimization services
into new value-based care delivery and payment
models.
Questions
A special thank you to
ACCP and the ACCP Research Institute!