Maria Bowen, PharmD Jaclyn Boyle, PharmD, MS, MBA, BCACP, BCPS

1. The Landscape of Practice Advancement in Ohio: Visualizing Our Course with the ASHP Ambulatory Care Self-Assessment Maria Bowen, PharmD Jaclyn Boyle, PharmD, MS, MBA, BCACP, BCPS University Hospitals Portage Medical Center

2. Objectives By the end of this presentation, the listener should be able to: • Explain the utility of the American Society of Health-System Pharmacists (ASHP) Ambulatory Care Self-Assessment • Discuss trends in Ohio Ambulatory Care Self-Assessment site and practitioner responses • Compare Ohio Ambulatory Care Self-Assessment data to other states

3. Vestibulum congue tempus Vestibulum congue tempus Overview of the ASHP Ambulatory Care Self Assessment Review Institutional Trends Vestibulum congue tempus lorem ipsum nec dolor Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor. Panel Discussion Lorem ipsum dolor sit amet, dolor at consectetur adipiscing elit, sed do eiusmod tempor. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor. Vestibulum congue tempus Vestibulum congue tempus Review Practitioner Trends Benchmark Ohio data with other states Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor.

4. The ASHP Ambulatory Care Self-Assessment: Overview

5. Practice Advancement Timeline 1985 2010 2011 2016 2014 OSHP/OPA/OCCP Ambulatory Care Summit ASHP Hilton Head Conference ASHP Ambulatory Care Summit OSHP Develops Practice Advancement Initiative Steering Group ASHP Pharmacy Practice Model Initiative Summit

6. The ASHP Ambulatory Care Self-Assessment Overview • 2 separate assessments: Practitioner and System • 30 minutes - 1 hour to complete • Should be completed by any site or practitioner providing (or planning to provide) outpatient pharmacy services (Hospital-Based Outpatient Clinics, Physician-Based Outpatient Clinics, specialty clinics, ACOs, PCMHs, etc.)

7. Assessment breakdown:

8. How can I find the Ambulatory Care Self-Assessment? http://www.ashpmedia.org/pai/

9. Benefits of the Ambulatory Care Self-Assessment • Determine alignment with ASHP Ambulatory Care Summit Recommendations • Provides baseline for practice advancement in ambulatory care • References/resources to improve/expand upon existing opportunities • Create actionable items to focus on • Contribute to strategic planning of department/health-system • Completing a re-assessment can demonstrate advancement • Others?

10. Benchmarking & Taking Action Note: You will need your ASHP member ID to retrieve the “Completions By State” or “Bench Mark Report”

11. Important reminders about the Ambulatory Care Self-Assessment • Complete the entire assessment • Revisit/reassess regularly • The action plan should be completed following the self-assessment • ASHP can provide comparative reports for multi-site health-systems • Excellent teaching and learning tool for student pharmacists and residents • Can be leveraged in resident research projects/expansion

14. Ohio Data: Let’s not get complacent.

15. Ohio Ambulatory Care Data • System N=20; Practitioner N=42 • Types of ambulatory services: • Both Primary Care and Specialty Clinics: 50% system vs. 57% practitioner • Primary Care Clinics only: 40% system vs. 33% practitioner • Specialty Clinics only: 10% system vs. 10% practitioner • Length of services existence: • Over 5 years: 50% vs 45% • 1-5 years: 20% vs 31% • Less than 1 year: 5% vs 10% • In planning stage: 15% vs 14%

16. Other Primary Position: Independent LLC Other Primary Position: Academia, Clinic and Retail Pharmacy

17. Other Primary Position: Pharmacy Intern x4

18. Other Primary Position: student pharmacist x2, clinical pharmacist and site manager, pharmacy intern x2

19. Scope of Services

20. Scope of Services

21. Strategic Planning (System only) Do you have a strategic plan that includes both ambulatory pharmacy patient care and scope of-service responsibilities (for ex: hours of service)? 45% responded “Yes” Are the ambulatory care pharmacy services mission, goals, objectives, and work consistent with those of the parent healthcare organization? 95% responded “Yes” Is there a written document that defines the ambulatory care pharmacy patient care scope of services? 50% responded “Yes”

22. What are the primary drivers in your practice setting for establishing pharmacists in ambulatory care?

23. What are the primary drivers in your practice setting for establishing pharmacists in ambulatory care? “Other” - practitioner assessment: insurance reimbursement, anticoagulation x2

24. Pharmacist training and credentials Does your organization have an ASHP-accredited ambulatory care residency training program (PGY1 or PGY2)? 45% (system), 60% (practitioner) Is there a requirement that pharmacists who provide patient care services in ambulatory settings have attained and maintain appropriate competencies and credentials? 60% (system), 70% (practitioner) Are pharmacists who provide patient-care services in ambulatory settings included in organization-based credentialing and privileging processes? 60% (system), 50% (practitioner) Do you have initial and ongoing professional practice evaluation? 65% (system), 50% (practitioner)

25. Program planning 75% (system) vs 70% (practitioner) have pharmacists who provide patient-care services in ambulatory settings entered into collaborative drug therapy management (CDTM)/scope of practice agreements). 70% (system) vs 80% (practitioner) have policies and procedures governing the scope of the pharmacist patient-care services provided in ambulatory settings (e.g., administrative, operational, and clinical) been developed. 65% (system) vs 90% (practitioner) have programs been developed to assist patients in accessing their medications, such as navigating formulary options, accessing patient assistance programs, and/or managing prior authorization requirements.

26. Respondents not billing for ambulatory services: 20% system, 17% practitioner

27. Other (system): not recognized as providers, departments already used billing code that can only be used once/yr, patient affordability Other (practitioner): can’t bill if seen by another provider, CMS recognition of pharmacists as providers, providers to bill under always available for billing

28. Pharmacists involvement in transitions of care

29. Pharmacy Technicians and Support Personnel Do you utilize pharmacy technicians or other supportive personnel to support pharmacist patient-care services provided in your setting? 75% (system) vs. 71% (practitioner)

30. Other (system) : scheduling, obtaining medications from outpatient pharmacy, managing referrals, appointment reminder calls Other (practitioner): APPE students perform these activities, medication and medical history

31. Outcomes evaluation (System Respondents) Has your organization, with pharmacist involvement, defined measures that correlate the value of pharmacists’ contributions to patient outcomes? 75% Is an ongoing process in place for reporting to medical staff, healthcare executives, and others regarding patient outcomes and pharmacist patient-care services provided in ambulatory settings? 60% Are the performance improvement activities for pharmacist patient-care services in ambulatory settings integrated with those of the health system or healthcare organization? 35% Are pharmacist patient-care services in ambulatory settings integrated into the healthcare organization’s efforts to encourage patients’ participation in and accountability for their care (beyond medication adherence)? 30%

32. Outcomes evaluation (Practitioner Respondents) Have you or other pharmacists in your practice setting defined measures that correlate the value of pharmacists’ contributions to patient outcomes? 60% Do you use a standardized format/template for documentation that facilitates outcomes Measurement? 60% Does your organization utilize a process for assessing and improving quality for pharmacist patient-care services in the ambulatory care setting? 50% Do you provide services to encourage patients’ participation in and accountability for their care (beyond adherence)? 80%

33. Ohio Comparative Trends

34. System Comparative Report • Ohio (N=19) • All states (N=258)

35. System Comparative Report “Which of the following are included within the scope of practice of pharmacists providing patient-care services in your ambulatory setting?” • Provide preventative care and wellness programs • Ohio: 58% • All states: 50% • Provide immunizations • Ohio: 63% • All states: 37%

36. System Comparative Report “Do you have a strategic plan that includes both ambulatory pharmacy patient care and scope-of-service responsibilities (for ex: hours of service)?” • Yes • Ohio: 47% • All states: 58%

37. System Comparative Report “Have you completed a comprehensive planning process for ambulatory pharmacist patient-care services?” • Yes • Ohio: 11% • All states: 29%

38. System Comparative Report “Are pharmacists who provide patient-care services in ambulatory settings involved when patients make any of the following transitions?” • Admission to the hospital • Ohio: 47% • All states: 27% • Discharge from the hospital • Ohio: 79% • All states: 46%

39. System Comparative Report “Has your organization, with pharmacist involvement, defined measures that correlate the value of pharmacists’ contributions to patient outcomes?” • Yes • Ohio: 74% • All states: 45%

40. Practitioner Comparative Report • Ohio (N=42) • All states (N=318)

41. Practitioner Comparative Report “Which of the following are included within your broad-based scope of practice?” • Order, interpret, and monitor medication therapy related tests • Ohio: 48% • All states: 69% • Include family caregivers in decision-making and communications • Ohio: 55% • All states: 75%

42. Practitioner Comparative Report “Have you utilized clinical and administrative leaders outside of pharmacy to promote and support your program?” • Yes • Ohio: 62% • All states: 76%

43. Practitioner Comparative Report “Is there a requirement that pharmacists who provide patient care services in ambulatory settings have attained and maintain appropriate competencies and credentials?” • Yes • Ohio: 71% • All states: 67%

44. Practitioner Comparative Report “Have policies and procedures governing the scope of the pharmacist patient-care services provided in your setting (e.g. administrative, operational, and clinical) been developed?” • Yes • Ohio: 81% • All states: 62%

45. Practitioner Comparative Report “Do you utilize pharmacy technicians or other supportive personnel to support pharmacist patient-care services provided in your setting?” • Yes • Ohio: 71% • All states: 56%

46. Maritosov AL, et al. Am J Health Syst 2018.

47. Panel Discussion

48. References Martirosov AL, Michael A, McCarty M, et al. Identifying opportunities to advance practice at a large academic medical center using the ASHP Ambulatory Care Self-Assessment Tool. Am J Health Syst 2018;75:987-92. Ohio Ambulatory Care Data - Provided by Dr. Eric Maroyka, Director, Center on Pharmacy Practice Advancement, American Society of Health-System Pharmacists