Telehealth medication management and health care spending in a Medicare Accountable Care Organization.

BACKGROUND: Value-based care is an opportunity for medication optimization services to improve medication management and reduce health care spending. The reach of these services may be extended through telehealth. However, as health care systems and payers grapple with the long-term financing of telehealth, real-world assessments are needed to evaluate the potential economic impact of pharmacy-driven telehealth services. OBJECTIVE: To evaluate the impact of a scalable pharmacist-driven telehealth intervention to improve medication management on health care spending for clinically complex patients who were enrolled in a Medicare Next Generation Accountable Care Organization. METHODS: Data for this pretest-posttest nonequivalent group design study came from Medicare claims from 2015 to 2020 and linked pharmacist care activity data derived from the electronic medical record. Patients in the intervention group were identified as those who received the telehealth medication management service. Patients in the control group were offered the service and refused or could not be contacted. The primary outcome was total medical spending over a 6-month period, and impact was assessed using a covariate-adjusted difference-in-difference model. RESULTS: There were 581 patients who received the intervention and 1,765 who served as controls. The telehealth intervention reduced total medical spending by $2,331.85 per patient over the first 6 months of the service ($388.50 per month; P = 0.0261). Across a range of estimates for the cost of service delivery, we find a return on investment of 3.6:1 to 5.2:1. CONCLUSIONS: The $388.50 monthly savings found in this study represent a substantial reduction in health care spending and emphasize the opportunity for telehealth delivery of medication management services to improve value as a part of alternative payment models. DISCLOSURES: This study was funded by the UNC Health Care Department of Pharmacy. Dr Urick has received personal fees from Pharmacy Quality Solutions and Cardinal Health. Drs Peters, Vest, Colmenares, Foushee, and DeFalco are employees of UNC Health Care Department of Pharmacy. Mr Easter received a Co-PI grant from NACDS Foundation to implement Community-based Value Care Initiative (CVCI) in a community pharmacy setting. He also received a grant to Eshelman School of Pharmacy. He has an individual consulting agreement with digital health company Truentity Health to provide go to market strategy for medication management services. He also has stock options from Truentity Health as a component of the consulting agreement. Dr Foushee has a leadership or fiduciary role at Member-At-Large and the Ambulatory Care Academy of the North Carolina Association of Pharmacists. At the time this work was conducted, Dr Urick, Dr Pathak, and Dr Blanchard were all employees of the UNC Eshelman School of Pharmacy.

Continuing professional development training program among pharmacist preceptors and nonpreceptors.

OBJECTIVES: To administer, observe, and evaluate the effectiveness of a condensed continuing professional development (CPD) training program among chain community pharmacy preceptors and nonpreceptors in North Carolina. METHODS: 120 community preceptors and nonpreceptors affiliated with a large community chain pharmacy completed a 5-hour CPD program consisting of home study and live portions and were given pre- and postintervention surveys. The main outcome measures were knowledge and familiarity of CPD among community chain pharmacy preceptors and nonpreceptors, effectiveness of the condensed training program, and perceptions on implementing the CPD process after training. RESULTS: Before the educational activity, differences between participants were (1) the percent of women pharmacists (40% of preceptors and 65% of nonpreceptors) and (2) that preceptors were more likely to accomplish planned learning activities compared with nonpreceptors. Of 97 nonpreceptors and 23 preceptors trained, more than 90% reported being able to achieve the program objectives and responded positively to the survey questions and 100% indicated that the educational activity enhanced their knowledge and skill levels. At least 85% of participants responded that the program length was satisfactory. The postsurvey revealed that 87% of participants were at least moderately familiar with the concept of CPD. Of respondents, 83% indicated that they will implement CPD at their practice site. CONCLUSION: A condensed CPD program is efficient and effective in training community chain pharmacy preceptors and nonpreceptors. The majority of the pharmacists who responded indicated that they will implement CPD at their practice site after going through this program.

Evaluation of a condensed training program to introduce the process of continuing professional development.

OBJECTIVES: Continuing professional development (CPD) is a novel approach to learning and developing as a professional. The purpose of this study is to administer, observe, and evaluate a condensed CPD training program to determine its effectiveness. STUDY METHOD: The program consists of a 2-hour home study section with reflective components and a 3-hour live portion complete with active learning activities and group exercises. Pre- and post-surveys were administered to participants, with several questions being asked to determine their perception of the CPD process. RESULTS: Of the 21 participants that attended the program, 99% indicated on the post-workshop evaluation that they were able to accomplish the pre-stated program objectives. Of the 19 participants who completed the pre- and post-surveys, 88% responded that the program time was just right for them. After the post-survey, 71% responded that they were very familiar with the concept of CPD as opposed to 11% on the pre-survey. CONCLUSION: A combined 2-hour self-study and 3-hour live interactive program is efficient and effective in training professionals on CPD.

Description of the characteristics of pharmacist-based immunization services in North Carolina: results of a pharmacist survey.

OBJECTIVES: To describe the characteristics of pharmacist immunizers and pharmacist-based immunization services in North Carolina based on immunizing pharmacist survey responses and to identify barriers and challenges to pharmacist-based immunization services in North Carolina. DESIGN: Descriptive, nonexperimental, cross-sectional study. PARTICIPANTS: All pharmacists with an active pharmacist license in North Carolina in early 2007. INTERVENTION: Electronic survey. MAIN OUTCOME MEASURES: Settings in which pharmacist respondents practiced, types of immunization services offered, level of participation in immunization services, and perceptions of possible barriers and challenges to providing pharmacistbased immunization services. RESULTS: 1,274 (12.8%) responses were included in the final analysis. Approximately 22% of respondents (n = 286) had completed an immunization certificate training program. Of these respondents, more than half (n = 148) had administered vaccinations in the past year (active immunizers). The majority (52%) of active immunizers had been in practice for fewer than 10 years and worked in either community chain or independent pharmacies. Almost all respondents actively involved in administering immunizations offered inactivated influenza immunizations (95.9%). A smaller percentage of pharmacists (39.2%) offered pneumococcal vaccinations at their practice site. All respondents were likely to perceive time and area/space as barriers to providing immunization services; each group also had several distinct perceived barriers. Many factors were perceived as barriers to pharmacists' ability to provide care by active immunizers. The majority of active immunizers were willing to provide additional vaccine types. CONCLUSION: This research has provided information about the number of pharmacists providing immunization services and characteristics of the services they provide. The demographics and settings of pharmacists in relationship to their engagement in immunization services are also provided. Last, the current work helps assess the perceived barriers to providing immunization services and pharmacist interest in expanded opportunities.