New patient-care opportunities begin with a "blueprint"

The integration of pharmacists’ services with standard delivery of patient-care services doesn’t happen in a vacuum. And it doesn’t happen overnight. It takes time, commitment, vision, networking, development of a “value proposition,” and an implementation plan.

Melissa Somma McGivneySee also: Health-system pharmacists empower the team

In addition, failure is not something to fear, because the pharmacist has learned something from the experience and can try again, said Melissa Somma McGivney, PharmD, FCCP, FAPhA, associate professor, Pharmacy and Therapeutics, and associate dean for Community Partnerships at the University of Pittsburgh School of Pharmacy.

“Ever since I became a pharmacist, I have been exploring opportunities that build on our basic mission of taking care of people in the community,” said McGivney, during a presentation at the 2016 American Pharmacists Association (APhA) annual meeting in Baltimore.

McGivney based her presentation on insights and conclusions derived from a 2014 APhA focus group that was composed of pharmacy leaders who had successfully implemented pharmacist-integrated care models.

Their success stories, she said, “went beyond the traditional pharmacy practice models. They were sustainable through actual payment for care.”

See also: Pharmacists' new role in team-based care

The panel

The 14 participants, who represented a variety of outpatient settings, convened at APhA offices in Washington, D.C., “to examine the common themes of success so we could organize the principles and make them accessible to other practices.” 

The group’s facilitators were McGivney; Anne Burns, BS Pharm, vice president, Professional Affairs, APhA; Brian Wall, PharmD, senior manager, Governance, APhA; and Sarah Drombowski, PharmD, BCACP, from Lake Erie College of Osteopathic Medicine.

“Our participating pharmacists were fascinating. The focus group collected their individual stories describing how their vision successfully implemented, replicated, and created a sustained pharmacist-integrated patient care model,” McGivney said.

A “blueprint” for success

The focus group reported its findings in the document “Nine blueprint elements for building a successful business case,” which offers structure and guidelines for pharmacists who want to move forward in their professional practice.

The blueprint begins with “understanding your own practice model; what is the standard protocol patients are familiar with and expect from a pharmacist? How does your model work?” This creates a solid foundation from which to move forward.

The standard practice model of dentists and doctors, for example, is the same no matter where a patient goes.

“Teeth are always examined starting with the same tooth and working around the mouth, and a physician always begins a physical exam from head to toe,” McGivney said. “In pharmacy, people expect to have their prescription filled and to talk to the pharmacist about their medicines.”

By advancing this practice, McGivney said, a pharmacist can move into doing more assessments.

For example, “Was the patient recently discharged from the hospital, and is this medicine for follow-up care? Are there medicines being prescribed by a different doctor who is unaware the patient has been hospitalized, which may pose risk?”

Patients’ lifestyles are also critical.

“Are there reasons they may not take it [the medication]? Can they afford it? Does it taste bad? Can they use the device
required? And do they have transportation for a refill?”

Need for a vision

In planning a new approach, “You have to have a vision of what you want to do [in terms of patient-care services] and align it with unmet needs,” said McGivney. “Reach out, be connected to other successful leaders, be team-oriented, find champions of your ideas, and understand what I call the system, or ‘the building you work in,’ to find resources that will help support and reimburse your services.”

While the process can be a maze, it is navigable, she said.

“Find out how the physicians in your system get paid - is it fee-for-service through Medicare Part D? Learn what it is and how it works, then look for needs that you can fill,” she said.

McGivney added that today’s mandate of pay for performance requires physicians to meet medication quality measures. This imperative gives physicians “an opportunity for partnering with pharmacists to help increase these quality measures.”

“Here is where the pharmacist can help a physician group with medication management and get paid in the process, as part of meeting those measures,” she said.

Champions of pharmacy

In her presentation, McGivney cited six examples of organizations outside the practice of pharmacy that have published position papers that support and promote the roles of pharmacists in integrated care, and the contributions they can make to patients and the healthcare team.

These include the National Governors Association, the Centers for Disease Control and Prevention, the National Coalition for County and City Health Officials, the American Academy of Family Physicians, the Patient Centered Primary Care Collaborative, and the Report to the U.S. Surgeon General.

All champion expanding pharmacy models and are potential avenues to reimbursement.