Health Care Environment

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2 Disclosures Anne L. Burns declares no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. 2

3 Objectives After this session, participants will be able to: Discuss factors that support provider status recognition for pharmacists. Describe pathways to provider status in the federal, state, and private sectors. Discuss barriers to pharmacists provider status at the federal level. Describe the components of the Patient Access to Pharmacists Care Coalition s federal ask. 3

4 Health Care Environment The health care system is undergoing a significant transformation in both the finance and delivery of health care services At the Federal level, Affordable Care Act implementation includes new individuals coming into the system and focus on new models of payment and care delivery e.g. accountable care organizations (ACOs), medical homes, etc. States are also examining their health care programs and defining policies that create efficient models of care and achieving improved quality and outcomes cost effectively Expansion of managed care and adoption of ACO model in state Medicaid programs 4

5 Health Care Environment Problems and Opportunities Total health care spending in the United States is expected to reach $4.8 trillion in 2021, up from $2.6 trillion in 2010 and $75 billion in Health care spending will account for nearly 20 percent of GDP, by The US spends almost $300 billion annually on medication problems including medication non-adherence. 2 Chronic diseases costs the US health care system $1.7 trillion annually (more than 75% of health care spending). 3 1.Centers for Medicare and Medicaid Services, National Health Expenditures Projections New England Healthcare Institute. Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease. August Partnership to Fight Chronic Disease Almanac of Chronic Disease. Available at: 5

6 Percentage of Medicare Fee for Service Beneficiaries by Number of Chronic Conditions 6

7 Health Care Environment Problems and Opportunities Nearly 70 percent of Americans are on at least one prescription drug, and more than 50 percent take two. 1 In 2011, there were nearly 4 billion prescriptions filled at US outpatient pharmacies an average of more than 12 prescriptions/person. 2 Almost 50% of people prescribed medications for chronic diseases do not take their medications correctly. 3 Pharmacists with their education and training (including more medication education than other providers) can help improve these statistics 1. Nearly 7 in 10 Americans Take Prescription Drugs, Mayo Clinic, Olmsted Medical Center Find, 2. Kaiser Family Foundation. 3. Sabaté E, editor., ed. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization;

8 Future of Health Care Continued movement toward quality and coordinated delivery of care (e.g. ACO, transition of care, etc.) Pharmacists can help with many of the known problems in the current health care system; when pharmacists are involved access is increased, quality is improved and costs are reduced Access Already primary care provider shortages across our nation and likely to worsen. Pharmacists, underutilized providers, are ready and willing to help Quality As the aging population continues to grow, medications will play an even greater role in the quality and cost of health care. Pharmacists have more medication education than any other health care provider Cost - Studies have demonstrated that successful coordination and management of transition of care services lower costs by positively impacting hospital readmission rates 8

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10 Future of Health Care Future of Health Care Examples of Pharmacists Services (cont): Health and wellness: Services such as annual and lifetime immunizations, blood pressure and cholesterol screenings, glucose testing, weight management, tobacco cessation counseling, and others. Care transition: Providing services to assist patients in transitioning smoothly from the hospital by ensuring proper medication management and preventing hospital readmissions 10

11 Pathways to Provider Status Federal Sector Social Security, Medicare Part B & D, CMMI, ACO Sustainable Growth Rate Federal Regulations (CMS, AHRQ, HRSA) State Medicaid Health Insurance Exchanges, state health plans Existing provider status and collaborative practice Private Payer ACOs Private or Employer-based Insurers Medical Homes 11

12 Growing Support for Pharmacists Value 12

13 13

14 Pharmacy Collaboration APhA is part of a broad coalition of pharmacy organizations and stakeholders united in promoting patient access and coverage to pharmacists patient care services Coalition seeking provider status for pharmacists including advocacy for: Consumer/patient access and coverage for pharmacists patient care services Payers and policy makers to recognize pharmacists as health care providers who improve access, quality, and value of health care Inclusion of pharmacists as members of patient health care teams 14

15 Patient Access to Pharmacists Care Coalition APhA AACP ASCP ASHP FMI IACP NCPA NACDS NASPA Rite Aid Walgreens Original members More to come! 15

16 Patient Access to Pharmacists Care Coalition 16

17 Patient Access to Pharmacists Care Coalition H.R Scope of Proposal Pharmacists State-licensed pharmacists with a B.S. Pharm. or Pharm. D. degree who may have additional training and certificates depending on state laws Services Services authorized under state pharmacy scope of practice laws Patients Services provided in/ for Medically Underserved Areas (MUA), Medically Underserved Populations (MUP), or Health Professional Shortage Areas (HPSA) 17

18 Patient Access to Pharmacists Care Coalition Are only a limited number of pharmacists eligible under H.R. 4190? 18

19 Patient Access to Pharmacists Care Coalition Are only a limited number of pharmacists eligible under H.R. 4190? 19

20 Patient Access to Pharmacists Care Coalition Feedback from Hill Positive feedback overall but cost is important Need to score low by Congressional Budget Office (CBO) Pharmacy challenged to be saver, not coster Concern by pharmacy that savings, especially those that are long-term, are not considered when scoring Hill equates provider status with fee-for-service Current focus is on new payment models (e.g. ACOs) What are Pharmacists Services and can t work in isolation 20

21 Patient Access to Pharmacists Care Coalition Next Steps Developing long-term strategy; this is not a sprint Education and Outreach Meet with Federal Agencies (e.g. HHS, FTC) and add provider status messaging in comments to regulations PAPCC continues to educate House and Senate members Work to increase membership o Include patient and other health care provider groups 21

22 Other Provider Status Activities Pharmacy Organization Value of Pharmacy Project Independent report released on May 21; available at Report explores pharmacists services currently being provided and their contribution to health/ health care system Identified the most recent U.S. research articles and focused on four pharmacist services and one care delivery arrangement: Medication management; medication reconciliation; preventive services; counseling; and collaborative care models 22

23 23

24 Ways to Optimize Pharmacists Value in States *Information provided by National Alliance of State Pharmacy Associations 24

25 Provider Designation Recent Wins *Information provided by National Alliance of State Pharmacy Associations 25

26 Provider Designation 26

27 Pharmacy Practice Act Optimization Scope/ Collaborative Practice Agreements (CPAs) Recent Wins *Information provided by National Alliance of State Pharmacy Associations 27

28 Pharmacy Practice Act Optimization Scope/ Collaborative Practice Agreements (CPAs) Recent Wins *Information provided by National Alliance of State Pharmacy Associations 28

29 Private Insurance Coverage Payment for Services There is nothing stopping private insurers from covering any service they find valuable Have to be prepared to demonstrate value and have plan for how the service will be able to be delivered Examples: Ohio, Tennessee *Information provided by National Alliance of State Pharmacy Associations 29

30 Payment for Services *Information provided by National Alliance of State Pharmacy Associations 30

31 Keep pharmacy unified Pharmacy s Next Steps Grow and strengthen PAPCC need to include patients and providers Be aware of the full range of opportunities and threats associated with access to old fee for service system Incorporate components and value of new payment models Look at congressional or agency areas of focus/ what they value e.g. transition of care, care coordination Lessen resistance by other health care providers 31

32 Pharmacy s Next Steps Take advantage of state laws and actions (e.g. health reform, and exchanges) Continue to demonstrate value Favorable quality/patient outcomes Impact on cost Highlight evidence and continue research As robust as possible but don t let the perfect be an enemy Data is important but may not need to be in peer-reviewed literature 32

33 Advocacy Resources APhA: PharmacistsProvideCare.com Join the Campaign! Fact Sheets Making the case HR4190 Public opinion polls Scope of practice Student Tool Kit 33

34 Resources Eight Modules on topics such as: ACO 101; ACO Financing Models; Healthcare Delivery in the ACOs; ACOs and Medication Use: What Matters; ACO Approaches to Medication Use; ACO Engagement of Pharmacists; Medicaid ACOs: Overview of State Activity and Pharmacist Engagement; ACO Highlights and Considerations for Pharmacists 34

35 35

36 Advocacy Resources Messaging Access to health care is a real issue for patients and pharmacists can help People on complex medications benefit from pharmacists services When pharmacists are on the patient s health care team, costs go down and quality improves While the successful passage of H.R is a priority for our profession it is critical to our patients 36

37 For more information on APhA s provider status activities Visit 37

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