Update on NC Pharmacy 2011


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Update on NC Pharmacy 2011

  1. 1. Update on NC Pharmacy 2011: Report from NCAP Fred Eckel, MS, FASHP Executive Director North Carolina Association of Pharmacists
  2. 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. 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. 4. Audience Response Question Will accountability be the NEW expectation for all health care providers this decade?1. Yes2. No
  5. 5. JCPP Vision 2015 Statement• “Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes.”
  6. 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. 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. 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. 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. 10. Audience Response Question What is the most important thing a pharmacist can do for a patient?1. Accurate medication dispensing2. Help manage chronic disease and provide medication therapy management3. Patient counseling on new prescriptions4. Focus on prevention including immunizations
  11. 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
  12. 12. Audience Response QuestionShould the patient’s pharmacistbe part of the Patient CenteredMedical Home?1. Yes2. No
  13. 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 patientsPatient Centered Primary Care Collaborative
  14. 14. Audience Response QuestionWhere should the pharmacistbe present?1. In the primary care office2. In a community pharmacy3. In an independent office practice4. In the patients home5. All of the above
  15. 15. Medical Home Role of Pharmacist ComponentPersonal •Provide Drug-therapy consultationsPhysicianPhysician- •Develop and maintain relationships with alldirected medical members of the practicepractice •Become a member of the practiceWhole-person •Evaluate and provide MTM targeting all of a patientscontribution conditions •Assign priorities for the patient’s medical agendaCoordinated and •Communicate consistently with other health careintegrated care providersSarah McBane, PharmD, CDE, BCPS
  16. 16. Medical Home Role of Pharmacist ComponentSafe and quality •Implement pharmacy-care principles to optimizecare safe and effective drug therapyEnhanced access •Remain available for patient consultations •Continue to be most accessible healthcare professionalAppropriate •Negotiate value of pharmacist services in thepayment and setting of team reimbursement modelsreimbursement •When allowable and appropriate, bill for pharmacy servicesSarah McBane, PharmD, CDE, BCPS
  17. 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 summaryNorth Carolina Pharmacist, Winter 2011
  18. 18. Audience Response QuestionIs it a conflict of interest forpharmacists to dispensemedication and influencemedication selection and use?1. Yes2. No
  19. 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. 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. 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 MTMSarah McBane, PharmD, CDE, BCPS
  22. 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 voiceSarah McBane, PharmD, CDE, BCPS
  23. 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 appreciatedSarah McBane, PharmD, CDE, BCPS
  24. 24. Audience Response QuestionDoes Community Pharmacyneed an Accreditationprogram?1. Yes2. No
  25. 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. 26. Audience Response Question Is there a need to evaluate the pharmacist competency beyond the NAPLEX?1. Yes2. No
  27. 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. 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. 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. 30. State of NCAP: Financials 2009 2010Revenues $693,002 $670,816Expenses $674,166 $699,669Total Assets $739,846 $775,582
  31. 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
  32. 32. Questions