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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
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
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