1. Update on NC Pharmacy
2011:
Report from NCAP
Fred Eckel, MS, FASHP
Executive Director
North Carolina Association of Pharmacists
2. Conflict of Interest
• I am a pharmacist by choice, training,
and employment, so I see life through a
pharmacist’s perspective.
• I have a personal faith that influences my
world view and colors how I interpret life
events.
• I am registered in a political party and
often see the issues through my political
lens.
3. Objectives:
• Address what roles pharmacists should play in
Health Care Reform
• Introduce Accountable Care Organization and
Medical Home model
• Address possible accreditation of community
pharmacies
• Discuss barriers to the progression of pharmacy
• Evaluate progress of pharmacist administered
immunizations
• Update on the state of NCAP
4. Audience Response Question
Will accountability be the NEW
expectation for all health care providers
this decade?
1. Yes
2. No
5. JCPP Vision 2015 Statement
• “Pharmacists will be the health care
professionals responsible for providing
patient care that ensures optimal
medication therapy outcomes.”
6. Audience Response
Question
Poor mediation adherence costs the U.S.
healthcare system how much annually?
1. $12 Billion
2. $35 Billion
3. $150 Billion
4. $290 Billion
(New England Healthcare Institute, 2009)
7. Medication Adherence
• This $290 billion is equal to 13% of the total
health expenditures in the United States
• Lack of adherence results in decreased
productivity, time off from work, and
increased utilization of physician and
Emergency Department visit and hospital
stays
• Opportunity for Pharmacist to take
the lead
(New England Healthcare Institute, 2009)
8. Health Care Reform
• Reform is inevitable
• The current system is not sustainable
• Focus of reform is accountability
• Pharmacists must ask: What is our role?
– Accountable Care Organizations
– Patient centered Medical Home Model
– Medication Therapy Management
– Medication Adherence
– Immunizations
9. Accountable Care
Organizations (ACO)
• A network of doctors and hospitals that
shares responsibility for providing care to
patients
• Fee for service is not eliminated but
bonuses are offered for keeping costs
down and meeting quality benchmarks
• Focus is on prevention
10. Audience Response Question
What is the most important thing a
pharmacist can do for a patient?
1. Accurate medication dispensing
2. Help manage chronic disease and
provide medication therapy
management
3. Patient counseling on new prescriptions
4. Focus on prevention including
immunizations
11. What should Pharmacists be
accountable for?
• Patient counseling
• Medication Therapy Management
• Medication Adherence improvement
• Chronic disease state management
• Improve transition of care
• Preventative Care
• Immunizations
13. Patient Centered
Medical Home (PCMH)
• Comprehensive primary care
• Facilitates partnerships between:
• Patients
• Patients’ personal physicians
• When appropriate, the patient’s family
• Primary care physician is reimbursed for
coordinating the care of patients
Patient Centered Primary Care Collaborative
14. Audience Response Question
Where should the pharmacist
be present?
1. In the primary care office
2. In a community pharmacy
3. In an independent office practice
4. In the patients home
5. All of the above
15. Medical Home Role of Pharmacist
Component
Personal •Provide Drug-therapy consultations
Physician
Physician- •Develop and maintain relationships with all
directed medical members of the practice
practice •Become a member of the practice
Whole-person •Evaluate and provide MTM targeting all of a patients
contribution conditions
•Assign priorities for the patient’s medical agenda
Coordinated and •Communicate consistently with other health care
integrated care providers
Sarah McBane, PharmD, CDE, BCPS
16. Medical Home Role of Pharmacist
Component
Safe and quality •Implement pharmacy-care principles to optimize
care safe and effective drug therapy
Enhanced access •Remain available for patient consultations
•Continue to be most accessible healthcare
professional
Appropriate •Negotiate value of pharmacist services in the
payment and setting of team reimbursement models
reimbursement •When allowable and appropriate, bill for pharmacy
services
Sarah McBane, PharmD, CDE, BCPS
17. Community Care of
North Carolina (CCNC)
• Hybrid fee-for-service and per member per month
reimbursement model
• Each CCNC network consists of nurse managers, social
work care managers, a medical director, and
pharmacists
• Pharmacists conduct a comprehensive medication
review and reconciliation using information obtained
from:
• Nurse care manager
• Primary care provider
• Hospital History & Physical
• Hospital discharge summary
North Carolina Pharmacist, Winter 2011
18. Audience Response Question
Is it a conflict of interest for
pharmacists to dispense
medication and influence
medication selection and use?
1. Yes
2. No
19. Medication Therapy
Management (MTM)
• MTM Empowerment Act (S.274, H.R.891)
• Expands eligibility criteria to:
• Seniors with any chronic disease
• First time dual eligible beneficiaries
• Individuals in transition of care
• Patients may use their pharmacy of choice
• Reimbursement based on time and resources
necessary
• NC ChecKmeds showed a $14 to $1 return on
investment- new slide with all programs
20. Evidence in North Carolina
• According to a cost-benefit analysis of the Health
and Wellness Trust fund:
• NC ChecKmeds, a medication therapy management
program, showed a $13.55 to $1 return on
investment
• NCRx, a premium assistance plan for low-income
seniors, showed a $13.96 to $1 return on investment
• MAP (Medication Assistance Plan), a medication
assistance program for all low-income North
Carolinians, showed a $15.15 to $1 return on
investment
21. Challenges to the evolution of
Pharmacy Practice:
• Response of other Health Care providers
– Physicians may feel threatened
– Limited knowledge of pharmacists training
and services we can provide
• Public perception
– Trust pharmacist in dispensing role
– Many are unaware of clinical services
including MTM
Sarah McBane, PharmD, CDE, BCPS
22. Challenges to the evolution of
Pharmacy Practice:
• Personality Traits
– Rule followers: creates discomfort when new
roles are developed
– I became a pharmacist because “I don’t want
to touch people”
• Professional Organizations
– Numerous organizations from a variety of
practice settings
– Lack of a unified voice
Sarah McBane, PharmD, CDE, BCPS
23. Challenges to the evolution of
Pharmacy Practice:
• Advocacy
– Pharmacists are typically reserved, in order
to progress we must be vocal
• Reimbursement model
– Currently focused on product
• Economic outcomes
– Asheville Project: fee for service
– Accomplishments not appreciated
Sarah McBane, PharmD, CDE, BCPS
25. Accreditation of
Community Pharmacies
• Pharmacists should be defining goals &
processes of accreditation
• The Joint Commission has helped advance
hospital pharmacy
• NABP initiated discussion for community
pharmacy accreditation program
• APhA is taking a leadership role by presenting a
policy statement at the 2011 meeting
26. Audience Response Question
Is there a need to evaluate the
pharmacist competency beyond
the NAPLEX?
1. Yes
2. No
27. Certification of
Practitioners
• BCPS Ambulatory Care
• 50 % of exam is direct patient care
• Will these pharmacists work in Physicians
offices, as part of an Accountable Care
Organization or as part of a Patient Centered
Medical Home?
• What will their role be?
28. Immunizations
• There is a large public health deficit in the area
of immunization administration
• There is an estimated 40,000 to 50,000
preventable deaths and $10 billion in
preventable health care costs due to lack of
immunizations each year
• Pharmacies provide convenient and cost-
effective locations for vaccination
29. Immunization Role Expansion in NC
• Senate Bill 246
• Pharmacists may administer all vaccines
to patients 14 and older with parental
consent without a prescription
• Pharmacists may administer all vaccines
to patients age 7-13 with parental
consent with a valid prescription
30. State of NCAP: Financials
2009 2010
Revenues $693,002 $670,816
Expenses $674,166 $699,669
Total Assets $739,846 $775,582
31. State of NCAP: Membership
Year Total Membership
2000 2,459
2001 2,530
2002 2,434
2003 2,527
2004 2,183
2005 2,337
2006 2,262
2007 2,278
2008 2,064
2009 2,701
2010 2,929
