Expanding the Role of the Pharmacist

1. Expanding the Role of the Pharmacist Enhancing Performance in Primary Care through Implementation of Comprehensive Medication Management

4. 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

5. 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.

6. Research Funding AnnouncementAmerican 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?

7. Enhancing Performance in Primary Care through Implementation of Comprehensive Medication Management

8. Study Leads Todd Sorensen, PharmD Co-Principal InvestigatorUniversity of Minnesota- College of PharmacyAlliance for Integrated Medication Management (AIMM) Mary Roth McClurg, PharmD, MHS Principal InvestigatorUNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Jennifer Carroll, MD, MPHCo-Principal InvestigatorAmerican Academy of Family Physicians-National Research Network

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

10. Hybrid Implementation-Effectiveness Design 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 • 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 Stage 4: Demonstrating the Value of CMM toward Achieving the Triple AIM Aim 4: Key Performance Measures and Effectiveness Improved Patient & Provider Experience (Satisfaction Measures) Lower Per Capita Cost (Return on Investment to the Practice) Improved Health (Clinical & Operational Measures) Stage 5: Scaling and Sustaining CMM Aim 5: Accelerating Spread and Adoption of CMM in Primary Care

11. 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

12. The InterventionComprehensive Medication Management

13. CMM Patient Care Process

14. Teams Drivers Active Implementation Usable Innovations • 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? Cycles Stages

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

16. Aim 4: Focused on Formal EvaluationYear 2 • Total cost of care / return on investment • Health services utilization • Quality metrics • Drug therapy problems • Patient and provider perceived value/satisfaction • Other

17. Financing/regulatory changes needed to implement more widely Integration of medication optimization services into new value-based care delivery and payment models.

18. Questions

19. A special thank you to ACCP and the ACCP Research Institute!