Report to the U.S. Surgeon General Highlights Pharmacists Delivering Expanded Patient Care Services

The U.S. Public Health Service (USPHS) released a report demonstrating, through evidence-based outcomes, that many expanded pharmacy practice models (implemented in collaboration with physicians or as part of a health team) improve patient and health system outcomes and optimize primary care access and delivery.

Specifically, the report makes the following recommendations:

Health leadership and policy-makers should further explore ways to optimize the role of pharmacists to deliver a variety of patient-centered care and disease prevention, in collaboration with physicians or as part of the health care team. These collaborative pharmacy practice models can be implemented to manage and prevent disease, improve health care delivery, and address some of the current demands on the health care system.

Use of pharmacists as an essential part of the health care team to prevent and manage disease in collaboration with other clinicians can improve quality, contain costs, and increase access to care.

Recognition of pharmacists as health care providers, clinicians, and an essential part of the health care team is appropriate given the level of care they provide in many h ealth care settings.

Compensation models, reflective of the range of care provided by pharmacists, are needed to sustain these patient-oriented, quality improvement services. This may require further evolution of legislative or policy language and additional payment reform considerations.

The report identified three demands within the health system that pharmacist-delivered patient care can help meet:

Chronic Care. Chronic diseases are the leading causes of death and disability in the United States. Chronic diseases currently affect 45% of the population (133 million Americans); account for 81% of all hospital admissions, 91% of all prescriptions filled, and 76% of physician visits; and continue to grow at dramatic rates. In addition, of all Medicare spending, 99% goes to beneficiaries with chronic disease.

Access to Care. Medically underserved patients seeking a health care home and the growth of primary care visits are two components that lead to insufficient time for focused or comprehensive disease or medication management and other related health care issues.

Provider Workforce. The primary care workforce may be unable to meet the demands of increased access to care. Physician shortages and maldistribution of health care providers affect the way we address this issue. The proportion of newly graduated U.S. medical students who choose primary care as a career has declined by 50% since 1997. Currently, it is estimated that more than 56 million Americans lack adequate access (not coverage) to primary health care because of shortages of primary care physicians in their communities. As millions of new beneficiaries enter the health care system, the situation will most likely worsen.

U.S. Surgeon General Regina Benjamin, M.D., MBA, commended lead author and Assistant Surgeon General RADM Scott Giberson, BSPharm, PhC, NCPS-PP, MPH, USPHS, and colleagues for their work and expressed her public support for the report.

Click here to read the report in full.
Click here to read Dr. Benjamin’s letter of endorsement.

Health Reform Implementation Update

Supreme Court Review of the Health Care Reform Law

On March 26, the U.S. Supreme Court heard oral arguments on the constitutionality of certain provisions of the Affordable Care Act (ACA). The court is expected to deliver its ruling in June.

The case, brought by 26 states and the National Federation of Independent Business (NFIB), focuses specifically on the legality of the individual mandate requiring almost all Americans to purchase health insurance.

Challengers argued that if government could force people to buy health insurance, what could government not force people to buy? However, past Supreme Court cases give Congress broad authority to regulate interstate activities affecting commerce, such as insurance.

The Obama administration has argued that opting not to buy health insurance affects commerce because uninsured people inevitably require health care and raise the costs for everyone.

The law’s challengers have argued that if the mandate is found unconstitutional, the entire law should be struck. Other legal experts predict that the court’s ruling will be limited to specific provisions around the individual mandate, which in theory would leave the remainder of the law in place.

From a political perspective, however, striking down the mandate would have a significant impact on the process of implementing the law and might undermine public support for the health care reform effort.

Click here to read more about the upcoming Supreme Court case.

Center for Medicare and Medicaid Innovation Report

The Center for Medicare and Medicaid Innovation (CMMI) released a report titled “One Year of Innovation: Taking Action to Improve Care and Reduce Costs,” detailing 16 initiatives involving more than 50,000 health care providers delivering care to Medicare and Medicaid beneficiaries in all 50 states.

These initiatives are focused on improving patient safety, promoting care that is coordinated across health care settings, investing in primary care transformation, creating new bundled payments for care episodes, and meeting the complex needs of those dually eligible for Medicare and Medicaid.

The release of the report is significant politically, after a request from three Republican senators – Orrin Hatch (R-UT), Mike Enzi (R-WY), and Tom Coburn (R-OK) – that the Government Accountability Office investigate CMMI to determine whether it is duplicating work that was already being undertaken by the Centers for Medicare & Medicaid Services (CMS).

Click here to read the CMMI report.

Pioneer Accountable Care Organization (ACO) Model Initiative Under Way

The CMS Innovation Center announced the launch of the Pioneer ACO Model, designed to support organizations operating as ACOs in providing more coordinated care to beneficiaries at a lower cost to Medicare.

Pioneer ACOs must be responsible for the care of at least 15,000 aligned beneficiaries (5000 for rural ACOs).

Thirty-two organizations were selected to participate in the initiative, which began January 1, 2012. In the first two performance years, the Pioneer Model will test a shared savings and shared losses payment arrangement determined through comparisons against an ACO’s benchmark, based on previous CMS expenditures for the group of patients aligned to the Pioneer ACO.

In year 3 of the program, the Pioneer ACOs that have shown savings during the first 2 years will be eligible to move to a population-based payment model. Population-based payment is a per-beneficiary per-month payment amount intended to replace some or all of the ACO’s fee-for-service (FFS) payments with a prospective monthly payment.

Beneficiaries receiving care through the Pioneer ACO Model will maintain the full benefits available under traditional Medicare (FFS), as well as the right to receive services from any health care provider accepting Medicare patients.

CMS has established quality measures that will be used to monitor the quality of care provided and beneficiary satisfaction. The agency will publicly report the performance of Pioneer ACOs on quality metrics, including patient experience ratings.

Click here to read more about the Pioneer ACO Model.

ACCP Political Action Committee (ACCP-PAC) and the 2012 Elections

2012 will be the first election year in which ACCP, through its Political Action Committee (PAC), will provide financial support to help elect candidates to Congress who share our vision for clinical pharmacy in an evolving health care delivery system.

Political contributions, together with direct lobbying and grassroots action, are a necessary tool to help develop relationships with members of Congress and educate them on the role of the clinical pharmacist delivering patient care as part of an interdisciplinary team.

Contributions to the ACCP-PAC will help advance ACCP’s long-term goal of targeted Medicare Part B payment reform (and parallel payment reform approaches in the private sector) for clinical pharmacists’ services within viable legislative vehicles in current and future Congresses.

ACCP-PAC Fundraising Challenge
The success of the ACCP-PAC depends entirely on the support of ACCP members. Although there are several PACs representing various segments of the pharmacy profession, ACCP has the only PAC dedicated to advancing the practice of clinical pharmacy.

Unlike contributions to the Frontiers Fund, contributions to the ACCP-PAC cannot be accepted from PRNs. All PAC contributions must be made by individuals from personal funds.

With more than 12,000 members eligible to contribute to the PAC, the ACCP-PAC is in a position to become one of the most prominent pharmacy PACs in Washington. To do this, we need the widespread support of our membership.

If each ACCP member contributes just $25, the ACCP-PAC will raise $300,000.

ACCP is pleased to report a 100% contribution rate among the Board of Regents and senior-level staff. All ACCP members should consider donating at least $25 to the ACCP-PAC.

CLICK HERE to support your PAC today!

ACCP-PAC Governing Council
The ACCP-PAC is directed by the PAC Governing Council, which provides oversight and strategic leadership for the operations of the ACCP-PAC.

The ACCP-PAC Governing Council consists of the following ACCP members:

ACCP funds the administrative expenses associated with operating the PAC, so all member contributions go directly to support pro-clinical pharmacy candidates.

2011–12 ACCP-ASHP-VCU Congressional Healthcare Policy Fellow Program

Derrick Griffing, Pharm.D., MPH, of Cicero, Illinois, has been named the 2012–13 ACCP-ASHP-VCU Congressional Healthcare Policy Fellow. The fellow program, now in its sixth year, provides pharmacists with unique insights into health care policy analysis and development under the auspices of the Virginia Commonwealth University (VCU) School of Pharmacy, the American College of Clinical Pharmacy (ACCP), and the American Society of Health-System Pharmacists (ASHP).

Dr. Griffing earned a Pharm.D. degree from Midwestern University School of Pharmacy in 2010 and a master’s degree in public health with a concentration in health systems and policy from Johns Hopkins University, Bloomberg School of Public Health, in 2011. He currently practices as an oncology pharmacist at The Johns Hopkins Hospital in Baltimore.

Dr. Griffing will begin his fellowship on September 1. After a structured orientation to Congress from VCU faculty and the Brookings Institute, Griffing will spend 1 month with the ASHP government affairs and policy team and 1 month with the ACCP government and professional affairs staff. In November, he will begin working as a policy fellow on a congressional committee or with the personal staff of a U.S. senator or representative.

About the ACCP-ASHP-VCU Pharmacy Policy Fellow Program
The Fellow program was launched in 2006 under the leadership of Gary R. Matzke, Pharm.D. (VCU School of Pharmacy), Ed Webb, Pharm.D., MPH (ACCP), and Brian Meyer (ASHP). The program was developed to provide active learning in several policy environments.

The initial month of the program consists of an orientation curriculum put on by the faculty of VCU and the government affairs staff of ACCP and ASHP. Fellows then spend 1 year on Capitol Hill as part of the staff of a congressional committee or the personal staff of a U.S. senator or representative.

The program provides a unique health care policy learning experience that allows the Fellow to make practical contributions to the effective use of scientific and pharmaceutical knowledge in government decision-making.

The Fellow is also expected to undertake a wide array of responsibilities in the congressional office he or she serves, including researching and writing briefs on health care issues; assisting with policy decisions; drafting memoranda; and planning, organizing, and contributing to the management objectives of the office.

Introducing the Pharmacy Healthcare Policy Fellows

2006–2007. The program’s inaugural fellow – George Neyarapally, Pharm.D., MPH – worked in the office of the Assistant Secretary for Preparedness and Response (ASPR) within the Department of Health and Human Services (DHHS) for 6 months, followed by almost 6 months in the office of Senator Joseph I. Lieberman (ID-CT).

Dr. Neyarapally went on to serve as a policy scientist in pharmaceutical outcomes research in the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality (AHRQ) and is currently a pharmacist at the Office of Surveillance and Epidemiology (OSE) within the Center for Drug Evaluation and Research (CDER) at the FDA.

2007–2008. Our second Pharmacy Healthcare Policy Fellow – Anna Legreid Dopp, Pharm.D. – took leave from her position as a clinical assistant professor at the University of Wisconsin School of Pharmacy to move with her husband to Washington, D.C.

Dr. Legreid Dopp also served in the office of Senator Joseph I. Lieberman. Dr. Legreid Dopp returned to Wisconsin and is currently working as a pharmacy benefit consultant at WEA Trust and a clinical pharmacist at Access Community Health Center. She is working toward a graduate degree in population health sciences, specializing in health services research, from the University of Wisconsin–Madison. In March 2011, Dr. Legreid Dopp became the editor of the Journal of the Pharmacy Society of Wisconsin.

2008–2010. Our third Pharmacy Healthcare Policy Fellow – Stephanie Hammonds, Pharm.D. – served on the majority staff of the Senate Health, Education, Labor and Pensions (HELP) Committee under the leadership of Senator Ted Kennedy (D-MA).

Dr. Hammonds was also selected as the 2009–2010 Fellow on the basis of her strong desire to continue her contribution to the health care reform initiatives overseen by the Senate HELP Committee.

After earning her fellowship, Dr. Hammonds joined the Health Resources and Services Administration (HRSA) in the Office of Pharmacy Affairs, where her work focused on the Patient Safety and Clinical Pharmacy Services Collaborative and Affordable Care Act provisions related to the patient-centered health home, care coordination during transitions of care, and clinical pharmacy services.

Dr. Hammonds currently serves as the manager of the Hospital Acute Care Pharmacies for LifeBridge Health in Baltimore, where her work blends policy and practice to develop a new community pharmacy business model.

2010–2011. Joshua P. Lorenz of Columbus, Ohio, was the 2010–2011 Congressional Healthcare Policy Fellow. Dr. Lorenz served as a Health Policy Fellow for the Minority Staff on the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) under Senator Mike Enzi.

Dr. Lorenz subsequently returned to Ohio, where he currently works as the medical science liaison at AssureRx Health.

2011–2012. Sarah Steinhardt, Pharm.D., J.D., M.S., of Lafayette, Indiana, is currently serving as the 2011–12 Congressional Healthcare Policy Fellow.

Dr. Steinhardt earned her Pharm.D. degree from Purdue University College of Pharmacy in 2003. She also earned a law degree with a health law concentration from the Indiana University School of Law-Indianapolis in 2009 and a B.S. degree in pharmacy administration from the University of Pittsburgh School of Pharmacy in 2010.

Dr. Steinhardt is currently serving in the office of Senator Ron Wyden (D-OR).

Applications for 2013–2014 Pharmacy Healthcare Policy Fellow Program
Interested candidates should visit the Pharmacy Healthcare Policy Fellow Program’s website for more information and instruction on submitting an application.

Contact ACCP Government Affairs Staff
For more information on any of ACCP’s advocacy efforts, please contact:

John K. McGlew
Associate Director, Government Affairs
American College of Clinical Pharmacy
1455 Pennsylvania Avenue NW
Suite 400
Washington, DC 20004-1017
(202) 621-1820
[email protected]