Practice Advancement Initiative (PAI): Pharmacist Roles in Public Health Eric M. Maroyka Pharm.D., BCPS Director, Center on Pharmacy Practice Advancement WMSHP Meeting January 2017
Disclosure • The presenter for this continuing education activity report no relevant financial relationships. • No off-label uses of medications will be described in this presentation.
Learning Objectives • Identify steps the pharmacy profession may take to help advance patient care contributions • Describe Practice Advancement (PAI) implementation, activities, and resources • Discuss the use of the PAI Hospital and Ambulatory Care Self-Assessments as strategic planning tools to advance pharmacy practice • Identify three areas where pharmacy professionals have a role in public health activities
The Big Picture Source: http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/#6157469458f9, accessed 14 July 2016.
Imperative for Change • Patient Protection and Affordable Care Act – Needs steady enrollment growth and enough healthy people to keep premiums in line – Focuses beyond acute care to value-based purchasing, population management, and cost mitigation • More consolidation will reshape healthcare landscape – Vertical integration (i.e., clinical and strategic) is taking place to diversify portfolios (e.g., insurance companies purchasing PBM and urgent care clinic operators) • Different models of care delivery and reimbursement continue to emerge (e.g., ACOs, PCMH, bundled payment arrangements) Managed Care. 2015; 24:30-47. Am J Health-Syst Pharm. 2016; 73:635-41.
Imperative for Change • Movement away from volume toward value-based payment (e.g., reward performance) • Aging population and declining Medicare beneficiary ratio amplifies unsustainable trajectory of healthcare spending • 40 percent of older Americans take at least five prescription medications, and the number is growing • Self-care, cost-effective innovations, and infrastructure to support “aging in place” (e.g., CMS Independence at Home demonstration project) Managed Care. 2015; 24:30-47. Am J Health-Syst Pharm. 2016; 73:635-41.
Key Points in 2016-2020 Report • Medication expenditures will increase by at least 5% annually until 2020 • Significant shift of health-system resources from inpatient to ambulatory care • Growing emphasis on population health management • Formal program in place to rigorously to coordinate post acute care services • Increase in mergers and acquisitions or partnering with outside entities to create economies of scale • Increase in patient assistance programs www.ashpfoundation.org/pharmacyforecast
Distribution of Outpatient vs. Inpatient Revenues Hospital Hospital Inpatient Outpatient Care Care http://www.aha.org/research/reports/tw/chartbook/2015/15chartbook.pdf, accessed 14 July 2016. Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2013, for community hospitals. Data for Chart 4.3
Essential Strategies to Expand the Pharmacy Enterprise • Change perspective • Understand and participate in the C- suite’s ambulatory care strategic plan • Assess revenue cycles • Invest in outpatient pharmacy, specialty pharmacy, and home infusion • Population health management • Transitions of care focused planning • Develop a layered learner model expanding student and resident training within primary care and ambulatory care • Actively engage technologies to reach ambulatory care patients • Market pharmacists’ value • Advocate for the profession Am J Health-Syst Pharm. 2016; 73:635-41.
ASHP Accredited Pharmacy Residency Program Growth in Last 30 Years 2500 PGY2 2,152 Specialized Clinical 2000 PGY1 1,917 Pharmacy Practice Hospital 1500 NOTE: Ambulatory Care +25 programs in last year (131 total PGY2 programs) 1000 500 0
Origins of PAI • Pharmacy Practice Model Initiative (PPMI) – started with invitational summit in November 2010 • The PPMI summit resulted in 147 recommendations and statements on the future of health system practice • An Ambulatory Care Summit (ACS) was held in March 2014, recognizing the acute care focus of PPMI and the clear need to bring focus to ambulatory care practice • The ACS14 resulted in 25 recommendations specific to practice in ambulatory care • In 2015, PPMI and ACS14 collectively were rebranded to…
Why the change from PPMI to PAI? • Pharmacy practice advancement not limited to inpatient care or just the hospital – “PPMI” was considered a hospital initiative by members • Allows us to broaden the scope to include both acute and ambulatory care settings • Practice advancement related to pharmacist’s role in transitions of care is included • PAI is not just a tool for managers but one that brings value to clinicians and extenders
Transforming how pharmacists in acute and ambulatory settings care for patients The Practice Advancement Initiative (PAI) is a profession-led initiative that is empowering pharmacists to take responsibility for patient outcomes in acute and ambulatory care settings. Leveraging Pharmacy Pharmacist Leadership in Care Team Integration Technology Technicians Credentialing & Training Medication Use Promotes a team-based Empowers the Elevates the reputation Evaluates the available Empowers pharmacists approach to health care pharmacy team to of the pharmacy team technologies to support to take responsibility for ensure that pharmacy patient safety and quality patient outcomes Shifts the roles of the technicians perform all Ensures pharmacists, of care healthcare team to traditional preparation residents, and students Positions pharmacists to enable pharmacists to and distribution activities have the training and Encourages use of promote health and optimize their time with credentials for activities available automation and wellness, optimize patients across the Urges technicians to performed within their technology to improve therapeutic outcomes, continuum of care handle non-traditional scope of practice now patient safety, quality, and prevent adverse and advanced and in the future and efficiency, while medication events Enhances the responsibilities and also reducing costs relationship between activities to allow Promotes the use of Emphasizes that, given pharmacists and pharmacists to take credentials to provide Identifies emerging their extensive education patients by positioning greater responsibility for services at the top of the technologies to improve and training, pharmacists pharmacists as direct patient care scope of practice pharmacy practice are integral to achieving healthcare providers the best outcomes Promotes technician training and certification requirements, such as the need for uniform standards for advanced technician roles
PAI: The Journey to Improve Patient Care
Polling Questions • How many of you have done an ASHP Hospital Self- Assessment? • How many of you know that there are two ways to take the Ambulatory Care Self-Assessment? • How many of you have read an article/case study/spotlight on the PAI website? • How many have used the State Affiliate Toolkit?
Hospital Self-Assessment • Complete Hospital Self-Assessment • Prepare Action Plan – identify priorities based on feasibility and impact • Consists of 106 questions designed to assess an individual hospital’s alignment with the recommendations • Covers a wide range of topics: – Advancing the application of IT in the medication-use process – Advancing the use of Pharmacy Technicians – Care team integration
1,718 assessments completed (24.42%) including DC and Puerto Rico Nine states have achieved ≥ 50% completion
HSA Action Plan Opportunities • Top Three Action List Priorities – Residency-trained pharmacists – Assigning initiation of medication reconciliation to appropriately trained pharmacy technicians to: • Capture admission and discharge medication histories for a reconciled personal medication list • Care coordinate patient assistance services for post- discharge medication use (e.g., ensuring patient access to affordable medications) – Provision of discharge counseling by pharmacists to include standardized process for hand-offs to next level of care (e.g., skilled nursing facility, home health) Data from 6/24/15 – 1631 assessments and 664 Action plans
The Hospital Self-Assessment is recommended for use by hospitals because: A. It provides a gap analysis to assist in identifying priorities B. It defines a preferred practice model C. It supports initiating practice change by providing reference sources D. A and C
Ambulatory Care Conference and Summit • Held March 2014 in Dallas, TX • Educational program and consensus recommendation development – Attendees participated in discussion and voting on recommendations – Proceedings published in AJHP August 15, 2014 • Four Domains: – Defining Ambulatory Care Pharmacy Practice – Patient Care Delivery and Integration – Sustainable Business Models – Outcomes Evaluation • Resulted in 25 recommendations – broad based statements with multiple components
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