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  • 2/20/2019

    1

    Tom Wadsworth PharmD, BCPS Associate Clinical Professor

    Idaho State University College of Pharmacy

    UAA/ISU Doctor of Pharmacy Program

    Anchorage, Alaska

    wadsthom@isu.edu

    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

    robiren2@isu.edu

    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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    2

    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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    3

    Prescriptive Authority

    “Scope Creep” Dispensing Dependent

    Payment Extra Training or

    Certification

    ≠ Pharmacist Provider Status

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    4

    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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    5

    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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    6

    A la

    sk a

    D H

    SS

    A K

    P h

    A

    U A

    A /I

    SU P

    h ar

    m D

    • 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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    7

    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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    8

    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

    Tra in

    in g

    C u

    rr ic

    u lu

    m R

    e fo

    rm

    S u

    p p

    o rt

    Professional Development

    Advocacy

  • 2/20/2019

    9

    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

  • 2/20/2019

    10

    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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    11

  • 2/20/2019

    12

  • 2/20/2019

    13

    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

  • 2/20/2019

    14

    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

  • 2/20/2019

    15

    SETMuPP Practice Transformation Demonstration Project

    Sustainable Education & Training Model under Pharmacist Provider Reimbursement

    • Informed legislative and advocacy - Statut

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