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? Which patients and populations would benefit the most from CMM? Among those who receive CMM, what is the impact on quality of care and cost? How is the clinical pharmacist integrated into the practice to ensure efficiencies and impact? What is the return on investment of having the clinical pharmacist embedded in the office or clinic? 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 Co-Principal Investigator University of Minnesota- College of Pharmacy Alliance for Integrated Medication Management (AIMM) Mary Roth McClurg, PharmD, MHS Principal Investigator UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Jennifer Carroll, MD, MPH Co-Principal Investigator American Academy of Family Physicians-National Research Network

CMM in Primary Care CMM Grant Steering Committee Payer Advisory Group American Academy of Family Physicians National Research Network (AAFP-NRN) National Implementation Research Network Minnesota Cohort (n=23) North Carolina Cohort (n=10) AAFP-NRN Cohort (MN, NM, NY, OH) (n=10) Alliance for Integrated Medication Management Center for Medication Optimization through Practice and Policy UNC Eshelman School of Pharmacy University of Minnesota-College of Pharmacy

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 Aim 2: Best Practices in Design & Delivery of CMM Stage 3: Building the Practice Management System to Support CMM Aim 3: System-level and Structural Elements to Support Effective & Efficient Delivery of CMM Stage 4: Demonstrating the Value of CMM toward Achieving the Triple AIM Aim 4: Key Performance Measures and Effectiveness 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 Health (Clinical & Operational Measures) Improved Patient & Provider Experience (Satisfaction Measures) Lower Per Capita Cost (Return on Investment to the Practice) 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 Hybrid Implementation-Effectiveness Design 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 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 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 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

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

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? Active Implementation Usable Innovations Stages Drivers Cycles Teams

Competency Drivers Organization Drivers Leadership Team development* Practice management assessment: DTPs not formally documented Usable Innovation*: Comprehensive Medication Management Usable Innovation*: Comprehensive Medication Management Operational Definitions Clear Description Fidelity Assessment Essential Functions Full Implementation defined as, 50% of patients at need of CMM services are receiving CMM with fidelity and with the intended outcomes. CMM Fidelity Patient care process assessment: DTPs not formally classified 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.

Aim 4: Focused on Formal Evaluation Year 2 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!