Optimizing patient outcomes: Health plans and pharmacists summit: Meeting proceedings.

OBJECTIVE: To convene a group of experts to define the value pharmacists provide to health plans, barriers to covering pharmacists' patient care services, and scalable solutions to cover pharmacists' services, specifically in the medical benefit. METHODS: The American Pharmacists Association (APhA) convened 31 experts, including physicians and pharmacists representing health plans (HPs), and pharmacist practitioners (PP) or organizations representing PPs for a strategic summit on May 16 to May 17, 2022, in Washington DC and Arlington, VA. A presummit survey was conducted to identify participants' perspectives on the value proposition of pharmacists and barriers to coverage for services. Day 1 of the summit featured a keynote presentation focused on the future of pharmacist-provided care. The second day included a framing session on the current state of coverage for pharmacists' services and the results of the presummit survey; four panel presentations on innovative HP program coverage; three breakout sessions to gather participant feedback on their experiences; and a final session prioritizing action items into an initial timeline of goals. A postsummit survey was fielded to rank feasibility and importance of opportunities and next steps for advancing coverage of pharmacists' services. RESULT: In general, there appeared to be consensus throughout the summit on the need to expand payer programs covering patient care services provided by pharmacists and the importance of continued collaboration between PPs and HPs to increase patient access to care. Participants highlighted a need for legislative and regulatory changes at the state and federal level for the expansion of some programs; however, there were many opportunities to expand programs without the need for public policy changes. CONCLUSION: The summit was a groundbreaking meeting between PPs and HPs that provided the foundation for collaboration and expansion of programs covering pharmacists' patient care services under the medical benefit. Key takeaways from the summit focused on the need for scaling programs; establishing mutually beneficial programs for patients, PPs, and HPs; and the need for partnership and flexibility from PPs and HPs as programs continue to establish and expand.

Politics, patients, and the role of the pharmacist: Addressing social and political issues that affect health care.

Pharmacists are well-respected health care practitioners tasked with providing optimal patient care while operating under an assigned code of ethics. Pharmacists know their responsibility regarding improving patients' health in the examination room, pharmacy, and hospital, but several factors influence the well-being of a patient that are not directly related to their therapy regimens. A patient's actions regarding political and social issues can have an indirect effect on their health and the health of others. As health professionals, are pharmacists duty-bound to alert patients to the impact of public policies on the health care system and their individual health? In addition, should pharmacists be able to assess when interventions are necessary and provide this education? As a profession, pharmacy must work toward creating guidance to help practitioners identify and address these issues with patients and encourage positive outcomes for individual patients and communities as a whole. Political and social issues will continue to become intertwined in the patient-practitioner relationship, and tools must be created to best navigate these delicate topics.

Pharmacist provider status: Geoprocessing analysis of pharmacy locations, medically underserved areas, populations, and health professional shortage areas.

BACKGROUND: Payment reform for pharmacists is both an important and urgent issue that needs to be addressed. OBJECTIVE(S): The purpose of this paper is to assess the use of medically underserved areas, medically underserved populations, and primary care health professional shortage areas in The Pharmacy and Medically Underserved Areas Enhancement Act; and provide policy recommendations for national pharmacy associations to achieve provider status. METHODS: Pharmacy location addresses were determined using public domain data from the National Plan & Provider Enumeration System (NPPES) National Provider Identifier (NPI) Registry. Medically Underserved Areas/Populations (MUAs/MUPs) and Health Professional Shortage Areas (HPSAs) were gathered through public data provided by the Health Resources and Services Administration as Keyhole Markup Language (KML) files. Addresses and KML files were analyzed and mapped using the geographic information software, QGIS. A series of maps depicting the location of all MUAs/MUPs, HPSAs, HPSA facility locations, and community pharmacy locations in the U.S. were then created. These maps were overlayed, and geoprocessing tools were used to create the analysis. RESULTS: After analyzing all community pharmacy locations in the United States, we found that only 56% are located within a current MUA/MUP or HPSA. The percentage of pharmacies in healthcare underserved areas differs widely between states from the lowest in New Jersey of 18.26% of pharmacies to the highest of Guam, the Northern Mariana Islands and the Virgin Islands with 100% of pharmacies. CONCLUSIONS: Aligning the pharmacist business model to be comparable to other health care professionals will ensure patients receive access to pharmacist-provided cognitive patient care services, which have higher value than product-centered services. Future attempts to recognize pharmacists as providers and allow for their reimbursement under Medicare Part B should consider strategies to increase the number of pharmacists that are eligible to participate in order to exemplify value to the public and elected leaders.

The pharmacist's role in advocating for the health care of immigrants in detention centers.

OBJECTIVES: The primary objectives of this commentary are to (1) summarize the role of pharmacists as an advocate for the health care and appropriate use of medications of migrants in immigration detention centers and (2) describe methods to advocate for this vulnerable population. SUMMARY: There is a current humanitarian crisis occurring within the United States that violates the responsibilities and values held by members of the profession of pharmacy. Reports by reputable news organizations and members of U.S. Congress have shared that there have been inappropriate distribution and use of medications in migrant detention centers along the southern border. Specific instances have been described, including lack of access to vaccinations and vital medications to control chronic conditions and treat acute conditions. The role of the pharmacist is to ensure safe and effective use of medications. This role is not being fulfilled at migrant detention centers in the United States. By advocating to elected leaders, the Department of Homeland Security, and Customs Border and Protection for legislation that ensures the appropriate use and access of medications for migrants in immigration detention centers, pharmacists can push for the appropriate care for this vulnerable patient population. CONCLUSION: The professional values of a pharmacist should not be hindered by a border or the citizenship of a patient. As is stated in the Oath of a Pharmacist, pharmacists must "consider the welfare of humanity and relief of suffering [their] primary concern." Through advocacy, pharmacists and student pharmacists can uphold their professional ethics and roles on the health care team by advocating for the care of a patient population that needs the profession's help.

Three ways to advocate for the economic value of the pharmacist in health care.

Numerous studies have demonstrated positive therapeutic and economic outcomes associated with pharmacist-provided care. However, public policy on provider status with subsequent payment for non-dispensing services has been slow to reflect an expanded pharmacist role. It is important for the public to understand the value of a pharmacist outside of the drug distribution system. Pharmacists and other health care and public health practitioners must share this information to further knowledge and affect policies and systems that can most effectively include pharmacists fully in the health care system. The 3 main areas identified in which the pharmacist has economic impact are decreased total health expenditures, decreased unnecessary care, and decreased societal costs. Evidence supports the economic value of the pharmacist; however, public opinion and political movements supporting patients' access to pharmacist-provided care are variable. Strategies to advocate and effect change include advocating to elected leaders for policy change and advocating to other health professionals, patients, and community members to better their understanding of the positive economic value of pharmacist-provided care. Through prioritizing community outreach and legislator education, pharmacist advocates can leverage 3 key areas in which pharmacists have economic value to advance policy and increase patients' access to care.

Determining and regulating scope of practice for health care professionals: A participatory, multiple stakeholder approach.

BACKGROUND: Scope of practice varies between health professions and states. OBJECTIVE: To explore stakeholders' preferences for determining and regulating health care professionals' scopes of practice. METHODS: Stakeholders in medicine, nursing, and pharmacy, including practitioners, leaders of professional associations, regulatory board members, and healthcare executives, were recruited via professional organizations, social media, and snowball sampling. Stakeholder preferences were collected using concept mapping, an integrated mixed methods approach which includes 1) brainstorming of statements and 2) sorting and rating of statements. Multidimensional scaling, hierarchical cluster analysis, and Mann Whitney-U tests were used for analysis. RESULTS: Thirty participants generated and sorted statements regarding preferences for scope of practice, creating eight clusters: 1) accountability to prioritize patient safety, 2) standardization, 3) collaborative regulation, 4) intra-professional regulation, 5) federal versus state, 6) role of non-health care professionals, 7) prioritization of patient outcomes, and 8) health care professional training and education. Fifty-seven participants rated statements in terms of importance and feasibility. Physicians and non-physicians held similar views on 68.5% (n = 37) and 81.5% (n = 44) of statements, respectively for importance and feasibility. The statements in the standardization and health care professional training and education clusters were perceived as the most important and feasible across stakeholder types.

A team-led remote ambulatory care rotation: Creating efficiency without sacrificing quality.

BACKGROUND AND PURPOSE: Advanced pharmacy practice experiences (APPEs) are a highly anticipated part of the doctor of pharmacy program. Traditionally, these rotations are offered as full-time, onsite experiences. However, there are situations in which geography, transportation, and housing requirements limit the accessibility of these experiences. Additionally, unexpected changes in rotation schedules or resource limitations may leave students in a difficult situation when completing their rotation hours. Having the ability to provide a remote APPE that results in similar student learning outcomes provides flexibility to experiential directors and ensures students' continued progression towards graduation. EDUCATIONAL ACTIVITY AND SETTING: A group of faculty members and post-graduate trainees collaborated to create a remote, one-month ambulatory care experience for 18 students over three months. Students had access to the electronic health record (EHR) from their homes through a partnership with a local federally qualified health center. Access to the EHR enabled the students to participate in telehealth visits and have meaningful interactions with patients as if they were on-site. Students were also able to participate in topic discussions, answer drug information questions, complete a literature evaluation series, and work on projects remotely through this rotation. FINDINGS AND SUMMARY: This remote rotation allowed preceptors to meet the educational needs of students while allowing them to provide patient care through telehealth. Data from summative student evaluations, student evaluations of preceptor and site, and a supplemental survey demonstrate that this remote rotation is a meaningful learning experience for students and is comparable to similar in-person rotations.

Current issues and recommendations to manage prescription drug benefits for public health programs.

Higher scrutiny is befalling public payors regarding drug costs and patient access to medications. These issues exist in a complex contractual environment where minimal oversight of pharmacy claim adjudication and reimbursement practices can occur. The complexity of prescription benefits, and the lack of defined expectations or accountability in the system contribute to a sense of frustration by the public. Key areas of improvement for this sector of the health care industry include legislative and regulatory shifts requiring ongoing analyses, reporting, and accountability of pharmacy benefit managers (PBMs) in order to improve payment transparency. These improvements will enable plans to eliminate misaligned incentives in the industry and drive value. Changes in public sector programs should be comprehensive in their approach so that the policy will result in a reduction in costs, enhanced patient access, better patient safety, and improved health outcomes.