Transcript
Page 1: SETMuPP Practice Transformation Demonstration Project€¦ · Practice Transformation Demonstration Project S ustainable Education & Training M odel under Pharmacist Provider Reimbursement

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Tom Wadsworth PharmD, BCPS Associate Clinical Professor

Idaho State University College of Pharmacy

UAA/ISU Doctor of Pharmacy Program

Anchorage, Alaska

[email protected]

Disclosure

We have no relevant financial relationships or commercial interests to disclose in conjunction with this presentation

SETMuPP Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider Reimbursement

Renee Robinson PharmD, MSPharm, MPH

Associate Professor Idaho State University College of Pharmacy

UAA/ISU Doctor of Pharmacy Program

Anchorage, Alaska

[email protected]

Learning Objectives Pharmacists

• Describe current barriers in Alaska that limit patient access to non-dispensing pharmacy services

• Explain the overall purpose, mission, vision, and timeline of the SETMuPP demonstration project

• Outline the underlying philosophies and values of the SETMuPP demonstration project

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Learning Objectives Technicians

• Define non-dispensing pharmacy services

• Explain the overall purpose, vision, mission, and timeline of the SETMuPP demonstration project

• Outline the underlying philosophies and values of the SETMuPP demonstration project

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Prescriptive Authority

“Scope Creep” Dispensing Dependent

Payment Extra Training or

Certification

≠ Pharmacist Provider Status

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Pharmacist Provider Status

Providing clinical services that are compensated within a fee-for-service construct Credentialed network provider within a health plans major medical benefit

=

Terms

•Non-dispensing pharmacy services - MTM - Medicare MTM - Post-Diagnostic Disease State Management - Vaccination - General health maintanence - Other

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Road to Provider Status

Pathway to Pharmacist Provider

Public Perception

Attitudinal Barriers

Federal and State Definition of Provider

Payer Credentialing

and Contracting

Pharmacist Billing

Literacy

01 02 03 04

Billing Resources

SETMuPP Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider Reimbursement

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Ala

ska

DH

SS

AK

Ph

A

UA

A/I

SU P

har

mD

• DPH/CDPHP

• Recognize Pharmacist Role

• Holds the CDC Grant DP18-1815

• Working Group

• Contracted with AK DHSS

• Demonstration Project

• Quarterly Reports

• Contracted with AKPhA

• Design SETMuPP

• House Funds • Reports

Quarterly

SETMuPP Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider Reimbursement

Overall Purpose

• Identify barriers in Alaska preventing pharmacist’s from being reimbursed as a medical provider when delivering non-dispensing services

• Create and implement resources/tools needed to overcome barriers

• Train and compensate pharmacists to bill as a medical provider

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SETMuPP Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider Reimbursement

Mission Address the gaps in healthcare access across Alaska through sustainable pharmacist provided healthcare services.

SETMuPP Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider Reimbursement

Vision Develop a practice transformation advocacy and training model that:

1) Advocates for policies and regulations which support reimbursement of pharmacist-billed cognitive services.

2) Supports use of provider mechanisms for pharmacist-billed cognitive services.

3) Provides student and pharmacist training and support to competently and proficiently bill for cognitive services.

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Advocacy

Pharmacist

Payers

Legislation

Curriculum Reform

Policy Makers

Patient Demand

Road to Provider Status

Overcoming Barriers Guiding Principals

Public Perception

Attitudinal Barriers

Federal and State Definition of Provider

Payer Credentialing

and Contracting

Pharmacist Billing

Literacy

01 02 03 04

Billing Resources

Train

ing

Cu

rric

ulu

m R

efo

rm

Su

pp

ort

Professional Development

Advocacy

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SETMuPP Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider Reimbursement

• Informed legislative and advocacy - Statute and Regulation review - Engagement of policymakers and payers - Identify needed legislative and regulatory change - Align with AKPhA Legislative effort to engage policy makers and advocate for change

• Training and support of practicing pharmacist’s - Resource and readiness evaluations - Training and resource toolkit - Monetary incentive

• Education of future pharmacist’s through curriculum change - Didactic – evaluation and management billing - Problem-based learning integration (simulation, note writing, and billing) - Electronic Health Record integration - Experiential practice

SETMuPP Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider Reimbursement

• Informed legislative and advocacy - Statute and Regulation review - Engagement of policymakers and payers - Identify needed legislative and regulatory change - Align with AKPhA Legislative effort to engage policy makers and advocate for change

• Training and support of practicing pharmacist’s - Resource and readiness evaluations - Training and resource toolkit - Monetary incentive

• Education of future pharmacist’s through curriculum change - Didactic – evaluation and management billing - Problem-based learning integration (simulation, note writing, and billing) - Electronic Health Record integration - Experiential practice

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Statute and Regulation Review

• Alaska statute definition of healthcare provider

• Alaska statute definition of medical care

• Alaska statute definition of pharmaceutical care

• 42 CFR 438.12 - Provider Nondiscrimination (Federal)

• Alaska Medicaid Eligible Providers – Pharmacist’s

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SETMuPP Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider Reimbursement

• Informed legislative and advocacy - Statute and Regulation review - Engagement of policymakers and payers - Identify needed legislative and regulatory change - Align with AKPhA Legislative effort to engage policy makers and advocate for change

• Training and support of practicing pharmacist’s - Resource and readiness evaluations - Training and resource toolkit - Monetary incentive

• Education of future pharmacist’s through curriculum change - Didactic – evaluation and management billing - Problem-based learning integration (simulation, note writing, and billing) - Electronic Health Record integration - Experiential practice

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SETMuPP Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider Reimbursement

• Informed legislative and advocacy - Statute and Regulation review - Engagement of policymakers and payers - Identify needed legislative and regulatory change - Align with AKPhA Legislative effort to engage policy makers and advocate for change

• Training and support of practicing pharmacist’s - Resource and readiness evaluations - Training and resource toolkit - Monetary incentive

• Education of future pharmacist’s through curriculum change - Didactic – evaluation and management billing - Problem-based learning integration (simulation, note writing, and billing) - Electronic Health Record integration - Experiential practice

Appeal

Claim Submission

Eligible Services &

Documentation

Credentialing & Contracting

Resource Assessment

SETMuPP Incentives

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SETMuPP Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider Reimbursement

• Informed legislative and advocacy - Statute and Regulation review - Engagement of policymakers and payers - Identify needed legislative and regulatory change - Align with AKPhA Legislative effort to engage policy makers and advocate for change

• Training and support of practicing pharmacist’s - Resource and readiness evaluations - Training and resource toolkit - Monetary incentive

• Education of future pharmacist’s through curriculum change - Didactic – evaluation and management billing - Problem-based learning integration (simulation, note writing, and billing) - Electronic Health Record integration - Experiential practice

Lectures

Problem Based Learning

Experiential Education

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Timeline

Statute & Legislative

Review

Establish Stakeholder

teams

Create SETMuPP Tool Kit

Establish Pilot Site

Implement 1st stage of

Curriculum Reform

Yr-1

Implement Advocacy

& Legislative Plan

Modify SETMuPP Tool

Kit

Establish 2nd Site

Implement Yr-2

Curriculum Reform

Yr-2

Modify Advocacy &

Legislative Plan

Develop SETMuPP Tool Kit

– Community Pharmacy

Establish Community

Pharmacy Site

Implement Yr-3

Curriculum Reform

Yr-3 Yr-4

Modify Advocacy &

Legislative Plan

Refine SETMuPP Tool Kit –

Community Pharmacy

Establish 2nd Community

Pharmacy Site

Implement Yr-4

Curriculum Reform


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