Primary Care Workforce Summit November 29, 2012 Country Springs Hotel, Waukesha Primary Care Workforce Summit Pharmacy Perspective Kate Hartkopf, PharmD UW Health Pharmacy Services Madison, WI

Primary Care Workforce Summit November 29, 2012 Country Springs Hotel, Waukesha Primary Care Workforce Summit Pharmacy’s vision for primary care delivery Continued evolution from the product to the patient – Historical emphasis on drug dispensing roles continue to move towards a more patient-focused, outcome-driven practice Regular contact with patients in the community can improve patient care by optimizing safe and effective use of medications – Pharmacists are one of the most accessible healthcare professionals Pharmacists seek to be integral members of a collaborative primary care team – Pharmacists can assist patients in reaching their medication therapy goals

Primary Care Workforce Summit November 29, 2012 Country Springs Hotel, Waukesha Primary Care Workforce Summit Pharmacy’s vision for primary care delivery Pharmacists possess the skills and training to monitor the appropriateness, adherence, safety, and cost of medications Pharmacists serve as primary care provider extenders – Chronic disease state management – Immunizations – Comprehensive medication reviews – Other pharmaceutical care services Pharmacists can improve coordination of care – Updates to the primary care provider and recommendations regarding drug therapies for their patients

Primary Care Workforce Summit November 29, 2012 Country Springs Hotel, Waukesha Primary Care Workforce Summit A statewide initiative to make quality- based patient care and medication therapy management services more accessible to both patients and providers The program is coordinated by the Pharmacy Society of Wisconsin (PSW) and teams: Wisconsin Community Pharmacies Patients Health Care Providers Health Plans The Wisconsin Pharmacy Quality Collaborative (WPQC): a model of pharmacy activity in primary care

Primary Care Workforce Summit November 29, 2012 Country Springs Hotel, Waukesha Primary Care Workforce Summit The Wisconsin Pharmacy Quality Collaborative (WPQC): a model of pharmacy activity in primary care Program components – Quality-based network requirements for participating pharmacies Audited by health plans each quarter – Patients are eligible for a variety of patient care services Services that occur in the usual pharmacist workflow and during consultation – Provider-approved dose adjustments, focused adherence discussions, extended patient instruction on new devices Comprehensive medication reviews that occur outside of the usual workflow Medication reconciliation service following hospitalization

Primary Care Workforce Summit November 29, 2012 Country Springs Hotel, Waukesha Primary Care Workforce Summit The Wisconsin Pharmacy Quality Collaborative (WPQC): a model of pharmacy activity in primary care Program goals – “Retool” community pharmacists as medication therapy managers – Enhance patient engagement in their care – Improve medication use by targeted patients Ensure appropriate medication use, assess adherence Focus on specific patient populations: diabetes, CHF, asthma and geriatric syndromes – Reduce prescription drug costs for patients and health plans – Reduce overall health care costs Identify situations where medication therapies can be improved, improve them, and thereby reduce overall costs of care

Primary Care Workforce Summit November 29, 2012 Country Springs Hotel, Waukesha Primary Care Workforce Summit The Wisconsin Pharmacy Quality Collaborative (WPQC): a model of pharmacy activity in primary care The vision of this initiative has earned national recognition with a $4.1 million CMS Healthcare Innovations Award Expected outcomes of the WPQC program during the 3-year CMS award period – Demonstrate substantial improvement in health of participating patients – Save over $20 million in healthcare costs

Primary Care Workforce Summit November 29, 2012 Country Springs Hotel, Waukesha Primary Care Workforce Summit Barriers and Challenges to Achieving the Pharmacy Vision for Primary Care Low reimbursement for drug product; reimbursement for services is limited, variable by health plan and inadequate at times Unclear perception of what a pharmacist can do – Public education about changing pharmacy roles is needed – Student exposure to the variety of roles available for pharmacists is necessary Medicare does not currently recognize pharmacists as “providers” Limited access to electronic medical records outside of health systems

Primary Care Workforce Summit November 29, 2012 Country Springs Hotel, Waukesha Primary Care Workforce Summit Barriers and Challenges to Achieving the Pharmacy Vision for Primary Care Limited availability of pharmacy residencies – Even fewer opportunities that emphasize ambulatory / primary care Limited opportunities for interprofessional education and practice Lack of incentives for high quality pharmacists in rural areas Change is difficult! – Movement to patient care services requires adequate staffing and expanded roles for pharmacy technicians – Resistance within the profession to change