Anthony P. Morreale, Pharm.D., MBA, BCPSNational Director, Clinical Pharmacy Services and Healthcare Services Research. Department of Veterans Affairs Pharmacy Benefits Management

Transformation of Clinical Pharmacy Practice in the VA:

Implications for Profession

ObjectivesObjectives

• Understanding the global goals of the VA Transformation of Ambulatory Care Practice including both primary care and Specialty Care

• Become knowledgeable about the strategies that VA PBM has taken to realign current operational and clinical practices to meet these challenges

• Create Awareness of the Challenges that exist in meeting these changes

• Understand the implications of the VA’s transformation on the practice of Pharmacy and on Healthcare reform

VA Transformational VA Transformational InitiativesInitiatives

Patient Aligned Care Team

• The Patient Aligned Care Team Model is a patient-driven, team-based approach that delivers efficient, comprehensive and continuous care through active communication and coordination of resources.

• PACT model puts the relationship with the provider and team at the center of a patient’s care, and has expectations for timely, continuous, patient-centered, and coordinated care.

Key Principles of Medical Home That Teams are Tasked to Meet

VA CPS Scope of Practice

Scope of Practice allows CPS to:• Work in concert with an attending physician• Evaluate medication therapy through direct patient

care involvement• Prescribe medications, devices and supplies to

include: initiation, continuation, discontinuation, monitoring and altering therapy without co-signature

• Perform physical measurements necessary to ensure appropriate patient clinical responses to drug therapy

• Order consults, as appropriate, to maximize positive drug therapy outcomes and disease state management.

• By working with a Scope of practice and not a protocol CPS can adopt practice changes quickly to reflect changes in literature, medication formulary and safety changes as well as new practice guidelines.

Why the CPS is Important to the PACT Team

PACT Pillars:Access – yellowCare Coordination – bluePractice Redesign - red

Midlevel Model with CPS : Chronic Disease Manager Model

Mid-level Providers provide MTM services to complex patients

Provider

Clinical Pharmacy Specialist

Complex Medication

Therapy Management

Clinical Pharmac

y Specialis

t

Chronic Disease Medication Management

• Chronic diseases have multiple drug therapy options to achieve therapeutic goals.

• VA’s National Formulary and PBM/MAP Criteria for Use documents provide patient specific criteria– CPS and Clinical Pharmacists are well

versed with the VA National Formulary and are VA experts on drug information, medication selection for specific diseases and medication safety (alerts and bulletins).

• CPS have the advanced skills necessary to provide Medication Management Services in Primary Care and Specialty Care

• The Clinical Pharmacist plays a vital role in dual-care management, therapeutic interchange, and medication reconciliation

Coordination of Care

Disease/Cohort Disease/Cohort ManagementManagement

Disease/Cohort Disease/Cohort ManagementManagement

Great Concepts But How Do You Make it Happen

Nationally?

Pharmacy Business Rules for PACTOverall Principles

Pharmacy Business Rules for PACTOverall Principles

Pharmacy Business Rules for PACTClinic Schedules

Pharmacy Business Rules for PACTTrainees

Pharmacy Business Rules for PACTClinic Leave

Educating Leadership How to Evolve

Educational Initiatives

Research Initiatives

National Implementation Challenges

National Implementation Challenges (cont)

Implications to the Pharmacy Profession

An Eye Toward the Future: Vision