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Pharmacists as Primary Care Providers – A Call to Action From Physicians!

26 Jun

Just in the last month two important opinion articles have come out advocating for expanded use of pharmacists in primary care. These are important articles and signify a growing trend in the market as they are written by doctors and they appeared in prestigious periodicals, the New England Journal of Medicine and the Journal of the American Medical Association.

The first viewpoint appeared in JAMA in the May 23/30, 2012 issue and was titled, “Retail Clinics and Drug Store Medicine.” The second appeared in the NEJM May 24, 2012 and was titled, “Sharing Care to Improve Access to Primary Care.” Both articles identify the growing crisis of lack of access to needed health care for patients and state that the skills of pharmacists can be a part of the solution. It is great to see such recognition taking place. This definitely is indicative of a trend forming and needs to be implemented into policy and practice acts for the betterment of patient care in the United States.

A Fifth Way To Reduce Deaths From Prescription Drugs

27 Feb

Last week’s Tuesday issue of the USA Today newspaper had a great editorial. It was titled, “Four ways to reduce deaths from prescription drugs.” The four ways were great; prescription monitoring, education, law enforcement, and insurance vigilance. How about a fifth way! Talk to a Pharmacist! The American Pharmacists Association recommends that everyone have their medications reviewed by a pharmacist once a year – and if someone is not on medications, they should also have a review to see if there are medications they should be taking. The use of prescription medications is taken for granted in the United States.

People should have their medications reviewed to see if they are:

1. On the best medications for their medical conditions – prescribers often get into a ‘comfort zone’ in prescribing and do not adapt new treatment guidelines,

2. Using the medications correctly and achieving the desired results – the problems of patients not understanding and following instructions are well documented. The percent who actually get to the recommended treatment goal is often very low.

3. What medications can be stopped or changed to achieve cost savings – People often go on taking medications for years without questioning whether they should stop.

Pharmacists are an underutilized resource in the health care system because they have not been included in the billing mechanisms for medical care. This needs to change. It would help improve the health care system and help improve people’s health.

It is remarkable that pharmacists still do not get the recognition they deserve after so much research has been done to prove the value of pharmacists’ services.

USA Today Editorial

[Spotlight Webinar] Implications of the CMS 2013 Call Letter on MTM Programs

23 Feb

The CMS 2013 Call Letter is here! Join me as I share the implications of the recently released Centers for Medicare and Medicaid Services (CMS) 2013 Call Letter on MTM programs. Learn what plan sponsors must do to comply with CMS requirements by January 1, 2013 and how to provide Medicare beneficiaries with standardized medication therapy management (MTM) and comprehensive medication reviews (CMRs):

• Standardized format and action plan
• Minimum service levels
• Important dates and times
• Outreach
• Measurement
• Awareness and value
• Program submission
• Annual cost threshold
• Chronic diseases

Space is limited, so I’m offering this free webinar twice:

February 28 | 12:00 pm CST | 1:00 pm EST

March 5 | 12:00 pm CST | 1:00 pm EST

I look forward to your participation!

Let’s go to sunny Florida for the 9th Annual Medicare Congress

30 Jan

Star Ratings are becoming more and more important to health plans and MTM programs every day. I will be speaking at the 9th Annual Medicare Congress taking place February 6-8, 2012 in Orlando. If you can, join me!

This is the largest and most sought after conference focused solely on Medicare Advantage. Health plans need the crucial information provided at this conference to stay competitive with ACOs, optimize their Star Ratings, withstand potential audits and sanctions, and shape their business plans in light of the uncertain outcome of the 2012 elections.

Brad Tice, PharmD

Chief Clinical Officer, PharmMD

Rising Star: Increase Your Rating in the Three Hardest Categories

Tuesday, February 7 at 4:15pm


I invite you to register for the conference as my guest and receive 25% off the standard registration price with Priority Code XP1707PHMD. Register by visiting the website, calling 888-670-8200, or emailing I hope to see you there! And if not, feel free to reach out for help with Stars and MTM!

U.S. Surgeon General Endorses Pharmacist-Provided Care

10 Jan

The New Year is not even two weeks old and already the value and importance of pharmacist-provided services ishighlighting the year! Yesterday, the U.S. Public Health Service with an official endorsement of the United States Surgeon General, Regina Benjamin, MD, MBA, released a report Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. This report outlines four focus points that make the case and present the roadmap for integration of pharmacists more fully into the patient care process.

Focus Point 1 of the Public Health Service report discusses how pharmacists are already integrated into primary care as providers. It discusses how pharmacists are involved in primary care within the Federal system and outside of the system through Collaborative Practice Agreements. I was fortunate to witness this first-hand the summer after my first year of pharmacy school. I was selected to do a COSTEP (Commissioned Officer Student Training Externship Program). When I look back to what has driven my focus on patient care and the appropriate use of medications, I look back to that internship as shaping my view of how pharmacy should be practiced.

Focus Point 2 discusses the need for recognition of pharmacists as health care “providers” in legislation and policy, and demonstrates how pharmacists are being held back from providing the full benefits to patient care because of the barriers that exist in payment models.

Focus Point 3 describes the need for “provider” status of pharmacists and highlights the need for expansion of MTM services. Many eligibility limitations are noted in the report that deserve just consideration. MTM has made significant strides since it was introduced in the Medicare Part D benefit in 2006, but the report is right to call out the limitations introduced through the defined eligibility restrictions and current model.

Focus Point 4 provides the evidence for the value of pharmacist services. Through a thorough literature review it shows that the average benefit gained through pharmacist services over nearly two decades of research was $10.07 per $1 of allocated funds. What more evidence do we need!

There is more evidence to support pharmacist-provided MTM services than in any other level of health care. What standard do we need to be held to? Where is the bar set? Improving the use of medications just makes sense. We pay for medications because they improve health conditions or help us to control them. Inappropriate use of medications is waste, resulting in paying for the medical condition and the medications. At PharmMD we see this every day. We have our clinical rules based on evidence-based medicine and we run them against the existing pharmacy and medical data. With all of the “care” provided by PBMs and the rest of the system, we still identify potential drug therapy problems in 20% to 40% of the population. We can do better!

Thank you Public Health Service Pharmacists and Thank you Surgeon General.

What is “Quality?”

31 Oct

“Beauty Is In The Eye Of The Beholder”

With the recent release of the 2012 Star Ratings measures and Accountable Care Organizations (ACOs) final regulations, quality is all the rage in health care. The quality engine of health care has been revving up over the last couple of decades, most likely sparked by the Bootman et al study in 2004 in the Archives of Internal Medicine showing the significant costs of drug-related morbidity and mortality and the Institute of Medicine (IOM) reports of the late 1990’s (To Err is Human and Crossing the Quality Chasm). With the Pharmacy Quality Alliance (PQA) starting up in 2006 to establish quality measures for medication use and medication therapy management (MTM) being established to be the “cornerstone” of the Medicare Part D benefit, significant work has accumulated in this timeframe to help establish “quality.” But what is “quality?”

Quality can certainly be elusive, especially in its measurement in health care. We most often rely on claims data used for billing purposes that has many limitations for measuring true quality. A good example is adherence. While typically measured using pharmacy claims data, we are not able to tell if the person is using the medication correctly or achieving the desired results of therapy – and by the way – what are the desired results? Do the results differ between the patient, the doctor, the payer or other stakeholders? Who should we listen to when defining quality?

I have had the opportunity to participate in several Technical Expert Panels (TEPs) in the development of quality measures. It has been an interesting process and very insightful. Identifying the measure concept and then seeing how the data (although yes, claims data) is analyzed to establish the measure and the population sizes needed for the evaluation provides interesting insights into how quality is measured today. Certainly, everyone that I have participated with has the best intentions in mind and is working within the data that is available. Still, none of these analyses have included a look at the impact on cost. Does achieving quality lower cost of health care? We all think it does, because of course, we are improving quality! (at least as measured across the population and as best we know given the available research).

It has been amazing to see how fast people (in this case health plans) have been to jump on Star Ratings. Quality measures have been out for quite some time. When I did the original environmental scan for quality measure for the PQA in 2006 there were over 1,400 just specific to the seven domains we were looking at. This should not be surprising. People will act in their own best interests (simple microeconomics). Without the financial incentives, the best interests of health plans is not always in alignment with improving quality in areas that they might not see the rewards from.

So for now, quality will be defined by quality measures as they are applied within performance measurement programs, like Star Ratings, ACOs, etc. The programs that have actual incentives (financial rewards or penalties) around quality measures will be used and targeted in the delivery of care, and we will all get excited when the quality measurement improves. We still have a lot to learn about “quality,” but we are at a welcome beginning and should embrace the opportunity to be incentivized in ways that will improve care – we hope!

American Pharmacists Month

18 Oct

October is a great month. I love the Fall with the cooler temperatures, changing colors of the leaves, football, and America’s Pharmacists Month. I had the pleasure of serving on the advisory committee when “National Pharmacy Week” was changed to “America’s Pharmacists Month.” The idea was to have a longer time period to showcase pharmacy across the United States. At the time, consumer research showed that 70% of consumers did not know the name of their pharmacist. I do not really know how much that has changed, probably not much, but the move to use it as an opportunity to better establish the pharmacy brand has been a tremendous success. The “Know Your Medicine, Know Your Pharmacist” message is clear, concise and easy to remember. I love seeing the messages on the morning talk shows as students and other groups appear and get their moment on camera. I love going to the APhA Annual Meeting and seeing the crazy ways student organizations have found to promote the month.

APhA has done a great job of getting increased awareness of pharmacist activities through this month. Each Fall, APhA uses its “Media Advisors Network” to increase exposure to pharmacy and create awareness. These advisors interview with media in New York to get articles and stories around the value pharmacists provide. There are also radio broadcasts throughout the month across the country.

We had our American Pharmacists Month celebration today at PharmMD and had a great cake made for the pharmacists internal to PharmMD. These are our internal pharmacists managing the development and logistics. To all of our pharmacists in our Virtual Network connected throughout the country, “Happy American Pharmacists Month!”

American Pharmacists Month Cake


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