Local Association Spotlight

By Casey Kamps, Pharm.D., staff pharmacist, Family Fare-Metro Health Village, KCPA president

Local Organization Name: Kent County Pharmacists Association (KCPA)

County Represented: Kent

What activities does your local association organize and conduct?

Kent County Pharmacists Association (KCPA) organizes a variety of activities. Activities include monthly Board Meetings, social events, holiday parties, continuing education (CE) sessions and other professional events. KCPA strives to provide meaningful events that offer Pharmacy Professionals the opportunity to network and socialize "outside of the office."

KCPA also prioritizes the support of other professional activities and organizations. KCPA provides  sponsorship opportunities for students and supports the Michigan Pharmacy Foundation (MPF).  KCPA sponsors deserving students to attend Professional Meetings and to host community events. In October, KCPA was a Silver Sponsor for the Michigan Pharmacy Foundation (MPF) Oktoberfest Event at Founders Brewing Co. in Grand Rapids. Annually KCPA supports the MPF Charity Auction by providing fun and unique gift baskets for raffle.

What is an example of an innovative event or initiative that your local as recently been engaged in, and how did that have a positive impact?

One of KCPA's priority initiatives is engagement. KCPA seeks to engage pharmacy professionals from all practice arenas. For some, involvement may mean sporadically dropping into meetings and for others involvement may mean obtaining a seat on the Board, and KCPA welcomes those at all ends of the spectrum to become involved.

In April 2016, KCPA hosted an inaugural event "KCPA Breakfast."  This event was in conjunction with Ferris State University's Annual Pharmacy Law Review.  KCPA hosted breakfast and coffee for students attending the Law Review and provided an informational booth. The booth provided students with information on how to identify local associations in their practice area(s) and how to become involved.  KCPA Board Members were on site to field questions and answers. Because the Law Review is geared for fourth year students preparing for licensure it was a great way to connect these students and to encourage them to become involved, or to stay involved, when they begin practicing professionally. 

How would someone get involved in your local if they were interested? How could they express interest in serving on your Board of Directors?

Check us out on Facebook at www.Facebook.com/kentcountypharmacistsassociation/. If you're not on Facebook, shoot us an email: KCPAPharmacists@gmail.com

Facebook is our primary means of communication, so meeting and event information can be found there.  If you're interested in attending a meeting or event, simply RSVP on Facebook or by email and show up!  Contact any Board Member for information about serving on our Board of Directors.

What is one thing that you would like student pharmacists and pharmacy professionals who are not involved in their local to know?

It is easier to become involved that you may think!  If you're a MPA member, you're already signed up!  KCPA welcomes everyone. Whether you are a new member, a veteran member, or somewhere in between, we'd love to have you involved!

By Insaf Mohammad, Pharm.D., PGY2 pharmacy resident, Detroit Medical Center

Background
The number of patients with chronic conditions and their contribution to healthcare expenditures in treating these conditions continues to grow.1 In 2010, over two thirds of Medicare beneficiaries had two or more chronic conditions. Of those, 14 percent had six or more chronic conditions.1 Such patients are responsible for a disproportionate number of hospitalizations, readmissions and total Medicare spending.¹ Care of patients with chronic conditions, however, remains suboptimal. An analysis of the quality of healthcare delivered in the United States revealed that patients with chronic conditions received less than 55 percent of recommended care.² Among geriatrics, a more vulnerable group of patients, less than 50 percent of recommended care was received.² Therefore, a considerable potential to improve outcomes exists if this gap in care can be bridged.

What is Chronic Care Management (CCM)?
The management of chronic disease states is complex and typically requires ongoing care delivered using multifaceted strategies. Historically, reimbursement in fee-for-service models for care coordination, education and counseling has been limited, particularly for non-face-to-face care.³ In an attempt to address the existing gaps in care, as of Jan. 1, 2015, Medicare began reimbursing non-face-to-face chronic care management (CCM) services provided to Medicare beneficiaries with at least two chronic conditions. The CCM service incentivizes the provision of continuity of care and comprehensiveness.^4-6 This is achieved via care coordination services, medication management and management at care transitions.^4,5 Reimbursement is available for patients who meet eligibility criteria and are provided with at least 20 minutes of non-face-to- face care coordination per month.

Both Medicare and the American Society of Health-System Pharmacists have endorsed pharmacists as “clinical staff” eligible to provide CCM services and billing under the supervision of a provider.⁷ The payment for CCM is approximately $40 billed under the Current Procedural Terminology (CPT) code 99490 once per calendar month, with higher billing codes available for time spent on more complex CCM.^7,8

Design and Implementation of a CCM Program
Although the Centers for Medicaid and Medicare Services (CMS) have not described a formalized approach for provision of CCM services, the pharmacy team at the Rosa Parks Wellness Institute for Senior Health (RP-WISH) in the Detroit Medical Center created a service model that meets the requirements they have set (Figure 1). At RP-WISH, electronic medical record (EMR) capabilities were used to create a dashboard of patients meeting eligibility criteria for service reimbursement. Such patients include those with at least two chronic conditions. The EMR dashboard includes several pieces of information, such as most recent HgbA1c values, blood pressure and hospitalizations within the past 30-days.

Once enrolled in the program, the CCM dashboard is used to prioritize which patients should be provided with CCM services first each month. We do this by providing services to patients most out of range from their goal HgbA1c or blood pressure. A member of the pharmacy team then provides a phone call focusing on the patient’s chronic care needs. This includes medication adherence, lifestyle education, vaccination recommendations and reinforcement of healthcare-related goals (i.e., HgbA1c, blood pressure, LDL). If the patient is unreachable by phone, a chart review is conducted. A summary of the phone call or chart review, including specific steps to attain their goals, is then mailed to the patient. Once the CCM encounter is complete, the details of the encounter are documented in the EMR and then sent to the primary care physician for co- signature.

Figure 1: CCM service workflow at the RP-WISH

The Impact of CCM

The Rosa Parks Wellness Institute for Senior Health (RP-WISH) is a designated patient-centered medical home located in the Detroit Medical Center, providing comprehensive primary and specialty care to over 3,000 patients 60 years of age and older. In August 2015, the pharmacy team at the RP-WISH implemented a CCM program that has enrolled over 150 patients to date. Our team includes a pharmacist, a PGY2 ambulatory care pharmacy resident and rotating students. We anticipate that the provision of CCM services will enhance the quality of care that we, as the healthcare team, provide to our patients. This non-face-to-face communication in between clinic visits reinforces medication adherence, improves coordination of care and enhances our relationship with patients. Overall, we anticipate that CCM will lead to positive health and economic outcomes in the ambulatory care setting.

References

1. Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD. 2012:1-30. https://www.cms.gov/Outreach-and-Education/Medicare-Learning- Network- MLN/MLNProducts/Downloads/ChronicCareManagement.pdf. (Accessed on September 22, 2016).
2. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003;348:2635-45.
3. Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA 2009;301:603-18.
4. Chronic Care Management Services. Department of Health and Human Services Centers for Medicare and Medicaid Services 2015;ICN 909188 May.
5. Chronic Care Management Tool Kit. American College of Physicians. 2015. https://www.acponline.org/system/files/documents/running_practice/payment_coding/medica re/chronic_care_manage ment_toolkit.pdf (Accessed on September 22, 2016).
6. Edwards ST, Landon BE. Medicare's chronic care management payment--payment reform for primary care. N Engl J Med 2014;371:2049-51.
7. Thompson CA. CMS explains Medicare payment for chronic care management services. Am J Health Syst Pharm 2015;72:514-5.
8. Medicare Program Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2017. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS). 2016. http://federalregister.gov/a/2016-16097 (Accessed December 9, 2016).

By Kali VanLangen, Pharm.D., BCPS, associate professor, Ferris State University

Michigan Pharmacists Association (MPA) is offering an exciting new membership option called CareerConnect for students in their last year of pharmacy school and new graduates. This new membership package was created with the new practitioner in mind to help them transition from the classroom into practice. CareerConnect also helps expose you to the pharmacy professionals looking to hire and recruit upcoming and recent graduates.

Why sign up for CarerrConnect?
CareerConnect can provide eligible individuals with a wealth of information and resources at the fraction of the cost if those same resources bought individually. Included in this package is up to 21 months of membership, complimentary registration to the annual MPA Pharmacy Law and Regulatory Review which prepares attendees for the Michigan Multistate Pharmacy Jurisprudence Examination (MPJE) as well as a complimentary copy of Michigan Pharmacy Law: A Guide to Statutes and Regulations. For individuals that are looking to get their first job, or for those that are looking to change career paths, there is an option to upload a CV to the MPA Talent Bank. Uploading your CV to the Talent Bank increases your visibility to pharmacy employers currently recruiting new pharmacists putting you one step ahead of the crowd.

It can be difficult for new graduates to stay connected with MPA when considering the cost of membership and all the other competing expenses they experience upon graduation including the NAPLEX exam, licensing fees and those dreaded student loans. CareerConnect is an affordable way for students to stay involved with MPA without the worry of renewing their membership until they have had the opportunity to acclimate to being a new practitioner.

How much does CareerConnect cost and how do I get started?

CareerConnect is currently available for $179 and signing up for CareerConnect is easy! Simply visit www.MichiganPharmacists.org/onlinestore and look for the CareerConnect Membership option.

Please help spread the word about this exciting MPA offer with any students or new graduates you may know. For additional information on this program please visit www.MichiganPharmacists.org/careerconnect or get in touch with Mike Wolf, MPA director of membership, at Mike@MichiganPharmacists.org or (517) 377-0231.

By Jodie Elder, Pharm.D., associate professor, Ferris State University

The Michigan Society of Health-Systems Pharmacists (MSHP) Ambulatory Care Committee is committed to advancing ambulatory pharmacy practice in Michigan. Since its inception two years ago, the committee has assembled a toolkit for ambulatory pharmacists. The MSHP Ambulatory Care Toolkit includes practical tools and resources to assist pharmacists with implementing successful patient care programs. The toolkit is available at www.MichiganPharmacists.org/ambulatorycare/practicetoolkit. Several sections expand to links for local and national ambulatory pharmacy resources.

Getting Started contains general information on conducting background research to identify potential gaps in care and suggestions for creating a plan for a new ambulatory pharmacy service. This section contains links to several “best practice” articles and information on development.

Business Models and Communication Resources includes information regarding building a sustainable business plan, billing opportunities and talking points for justifying services to stakeholders. It also contains links to articles describing use of technicians and support personnel to help improve financial viability of services provided.

Clinical Practice Resources contains links to the ASHP assessment tool and information regarding documentation of services and development of patient assessments. Several links include information about collaborative practice agreements (CPAs) to help providers get started with chronic care management. In addition, useful assessments for medication adherence, health literacy and potentially inappropriate medications are provided for pharmacists’ use.

Outcomes evaluation and application of quality-improvement principles to ambulatory care pharmacy practice is necessary for demonstrating value. Suggestions for outcomes measurement and evaluation are provided and several links to pertinent quality measures are included to help pharmacists get started.

Advocacy and Provider Status includes links to local and national organization pages and serve as a resource for pharmacists to engage in promotion of pharmacy services and advocate for provider status.

Transitions of Care Model Resources includes a description of key aspects of effective Transitions of Care (TOC) and several links to websites, articles and toolkits to assist pharmacists with providing the highest quality TOC services.

Other Resources contain links to books and additional resources available through other organizations for purchase. The references listed contain detailed examples of treatment protocols, program development materials and collaborative practice agreements.

The goal of this toolkit is to assist pharmacists desiring to expand ambulatory pharmacy services and opportunities in Michigan. The toolkit is public, however only MSHP/MPA members can sign in and access a database of pharmacists providing ambulatory services in Michigan, their location and types of services provided. If you are already providing ambulatory care services, please consider filling out the ambulatory pharmacy site form for inclusion in the database at www.MichiganPharmacists.org/AmbulatoryCare. Together, we can expand and improve the care delivered in the ambulatory setting. We welcome comments and feedback and are committed to continually improving this toolkit. Please feel free to contact Sarah Barden, PSI director of business development and MPA liaison, by email at Sarah@michiganpharmacists.org with questions or feedback.

By Brooke Malone, Pharm D. candidate 2017, Ferris State University College of Pharmacy

As my P3 year was drawing to a close, I remember having mixed emotions of being ecstatic to be done with the didactic portion of pharmacy school, as well as terror of what would be expected of me while I was out on my rotations as a P4. I assumed that my P4 year would be a year-long test to see if I could handle being a pharmacist on my own. While the purpose of your rotations is in part to test your knowledge of pharmacotherapy, it is very important to remember that it is still school. None of your preceptors are going to expect you to be an expert on your very first day of a rotation; instead, they want to see that you grow throughout your experience with them.

The best way to impress your preceptors, and to gain the most out of your rotations, is to drive your own education. Any time that you come across a disease state that you aren’t very familiar with, or a drug that you’ve never heard of before, take some time to look up information about how that disease presents, the typical treatments that are used, the mechanism of action of the drugs and common side effects that are seen. Your preceptor may not specifically ask you to know all of this information; however, you will need to know these things in order to pass your boards and work as an effective pharmacist. Taking your education into your own hands is the best way to excel in your final year of pharmacy school.

Another important step to take is to ask for critical feedback. Your preceptors should give you, at minimum, a review in the middle of your rotation as well as at the end. If it seems that your preceptor is only giving positive feedback, challenge them to come up with a few areas that you need to improve. No one is perfect; however, sometimes preceptors can be hesitant to give too much constructive criticism.  I spent my first rotation thinking that my preceptor loved me because all she ever did was sing my praises, only to walk into my final review session to hear that she thought I had an overwhelming personality that was intimidating to patients and other providers. I would have much preferred hearing this earlier in my rotation so that I could try and change my behavior, but it never occurred to me to ask for more criticism earlier in my rotation.

At the end of the day, your experience as a P4 is entirely what you make of it. The majority of your days will be spent on your own looking at patients and deciding on how to best manage their care. Bettering yourself in terms of expanding your knowledge and adjusting your behaviors in response to critical criticism are the best ways to ensure patients receive the finest care and that you make the most out of your P4 rotations.