Leadership Roundtable June 2011 Leadership Roundtable June 2011 RADM Scott Giberson, RPh, PhC, NCPS-PP, MPH U.S. PHS Chief Professional Officer, Pharmacy U.S. Assistant Surgeon General Accelerating Effective Pharmacy Practice Models

Panel Objectives Provide brief update on need for practice innovation Discuss innovative models of success and ongoing challenges Facilitate critical conversation on lessons learned (payer and provider perspectives) and next steps

Expand Pharmacy’s Scope and Impact The Nation has needs: –Access –Quality –Cost –Safety The Profession has capacity and skill: –Direct Care –Public Health –Health Leadership The Nation has needs: –Access –Quality –Cost –Safety The Profession has capacity and skill: –Direct Care –Public Health –Health Leadership G reat disparity exists between the goal of optimal health outcomes and maximal use of all health professionals May become an under-resourced and overburdened healthcare delivery system

Diverse Scopes 2011 and Beyond Assure patient and health system “safety” Deliver Patient Care HP/DP, Patient Wellness EpidemiologyEmergency ResponseHealth Leadership Public Health Scope

Clinical (‘Primary’ Care) Scope Focused management of diseases Interview, chart review Prescriptive and Lab Authority Physical assessment Patient education and follow up Care coordination Health Promotion/Disease Prev. Improving adherence CDTM, MTM Privileges may include: Privileges granted locally by medical staff.

What process was employed to make the pharmacist-delivered service consistent in process and quality? How did the service transition from a local practice model to a national level program? Who were the champions of the practice model? How did you get their buy-in? What are the processes for continuous innovation, improvement? What lessons were learned from the process of developing a national program? What were the roadblocks? What process was employed to make the pharmacist-delivered service consistent in process and quality? How did the service transition from a local practice model to a national level program? Who were the champions of the practice model? How did you get their buy-in? What are the processes for continuous innovation, improvement? What lessons were learned from the process of developing a national program? What were the roadblocks? Practice Models

National Clinical Pharmacy Specialist (NCPS) Program Reviews and recognizes credentials of local Clinical Pharmacy Specialist (CPS) Assures and promotes uniformity of clinical competence through national certification Serves to promote universal recognition of pharmacists as billable health care providers Captures value and impact from those services Continues program expansion and innovation Reviews and recognizes credentials of local Clinical Pharmacy Specialist (CPS) Assures and promotes uniformity of clinical competence through national certification Serves to promote universal recognition of pharmacists as billable health care providers Captures value and impact from those services Continues program expansion and innovation To develop and implement a national program and process that:

Scope Intended to recognize advanced scopes of practice at local level that satisfy uniform national guidelines Involve management of disease through therapy Care/Privileges must include: –Interview, chart review –Laboratory privileges –Prescriptive authority –Physical assessment –Patient education and follow up NCPS grants a certification Privileges are granted locally by medical staff Intended to recognize advanced scopes of practice at local level that satisfy uniform national guidelines Involve management of disease through therapy Care/Privileges must include: –Interview, chart review –Laboratory privileges –Prescriptive authority –Physical assessment –Patient education and follow up NCPS grants a certification Privileges are granted locally by medical staff

Certification Process: Local vs. National Pharmacists locally privileged. Work to satisfy national requirements Re-certification every 3 yrs: ongoing practice hours and CE Continue to practice locally, now as NCPS pharmacists assuring similar scope and quality Submit credentials to NCPS Committee for review 1.Experiential components: i.2-4 yrs in clinical PHS pharmacy practice ii.> 1 year in clinical practice with requested privileges as local clinical pharmacy specialist 2.Attestation letters from physician 3.Didactic Credentials 4.Annual patient contact hours 5.NCPS-approved Collaborative Practice Agreement (CPA) 1.Experiential components: i.2-4 yrs in clinical PHS pharmacy practice ii.> 1 year in clinical practice with requested privileges as local clinical pharmacy specialist 2.Attestation letters from physician 3.Didactic Credentials 4.Annual patient contact hours 5.NCPS-approved Collaborative Practice Agreement (CPA)

Collaborative Practice Agreements (CPAs) NCPS approves a CPA for each NCPS pharmacist, to assure uniformity in process, scope and quality CPAs are reviewed for these critical elements: –Rationale (Justification), Purpose –Clinic Policy and Procedures (CDTM + ) –Clear Indication of Privileges (the “Big 3” scope) –Performance: QA and Outcomes –Training and Local Attestation –Privileging/Re-Privileging –Clinical Information: National Guidelines –Appropriate Signatures The “rationale” for CPA NCPS approves a CPA for each NCPS pharmacist, to assure uniformity in process, scope and quality CPAs are reviewed for these critical elements: –Rationale (Justification), Purpose –Clinic Policy and Procedures (CDTM + ) –Clear Indication of Privileges (the “Big 3” scope) –Performance: QA and Outcomes –Training and Local Attestation –Privileging/Re-Privileging –Clinical Information: National Guidelines –Appropriate Signatures The “rationale” for CPA

Process and Patient Impact Process –Uniformity of scope and documented outcome –Best practice model standardization –Uniform process that reviews training, attests to knowledge and education –Helps to assure clinical competence –External expansion was another step to uniformity Patient –Access to care –Quality care (clinical/admin outcome, safety) –Inter-professional support Process –Uniformity of scope and documented outcome –Best practice model standardization –Uniform process that reviews training, attests to knowledge and education –Helps to assure clinical competence –External expansion was another step to uniformity Patient –Access to care –Quality care (clinical/admin outcome, safety) –Inter-professional support

Example of Physician Survey Results (n=117 physicians) 96% of respondent-physicians reported benefit(s ): improved outcomes increased return on investment allowing for physician shift in workload increased patient access to care

Change the Paradigm: 1.Value local privileging based on practice setting 2.Assurance of competency 3.Involve physicians and patients in planning and marketing 4.Illustrate patient AND administrative outcomes 5.Base service on need Report to the Surgeon General Federal Pharmacist Vision Change the Paradigm: 1.Value local privileging based on practice setting 2.Assurance of competency 3.Involve physicians and patients in planning and marketing 4.Illustrate patient AND administrative outcomes 5.Base service on need Report to the Surgeon General Federal Pharmacist Vision Continuous Innovation

We ARE health care providers We ARE public health professionals We ARE part of national health leadership Challenges (‘Roadblocks’) 1.Compensation based on level of service 2.Uniformity of message – lack of common vision 3.Dispelling the myths Territory? Education Level? Outcomes? 4.Practice setting 5.Legal barriers We ARE health care providers We ARE public health professionals We ARE part of national health leadership Challenges (‘Roadblocks’) 1.Compensation based on level of service 2.Uniformity of message – lack of common vision 3.Dispelling the myths Territory? Education Level? Outcomes? 4.Practice setting 5.Legal barriers Critical Conversation

Continue to have uniform messageContinue to have uniform message Keep all the doors open for pharmacistsKeep all the doors open for pharmacists Lead change for patients and health systemsLead change for patients and health systems Focus efforts on broad conceptsFocus efforts on broad concepts Leverage federal pharmacy practiceLeverage federal pharmacy practice We shouldn’t be our harshest criticsWe shouldn’t be our harshest critics Continue to have uniform messageContinue to have uniform message Keep all the doors open for pharmacistsKeep all the doors open for pharmacists Lead change for patients and health systemsLead change for patients and health systems Focus efforts on broad conceptsFocus efforts on broad concepts Leverage federal pharmacy practiceLeverage federal pharmacy practice We shouldn’t be our harshest criticsWe shouldn’t be our harshest critics Call-to-Action