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Advocacy Update

Health Care Reform Update, Spring 2010

If the battle over health care reform taught us anything, it is, “never try to predict the future.” Throughout 2009, informal deadlines to pass legislation slipped from the August recess to Thanksgiving, then Christmas, and then to the President’s State of the Union address in January.

Massachusetts, the commonwealth that has consistently elected Democratic heavyweights from Ted Kennedy to Tip O’Neill, from John Kerry to Barney Frank, surprised everyone apart from perhaps the charismatic candidate himself when voters sent Republican Scott Brown to the U.S. Senate.

Yet, despite the President’s plummeting approval ratings, the loss of the 60-seat supermajority in the Senate, and the overall perception of the Democrats as a party in disarray, President Obama signed a landmark health care reform package into law on March 23, 2010.

The new law, known as The Patient Protection and Affordable Care Act (PL 111-148), recognizes among its many critical reform provisions the medication use problems our country faces and provides support for expanding and supporting the role of the clinical pharmacist in addressing these problems. The law also delivers a series of health care delivery reforms to promote coordination among health care providers and several important changes to the Medicare Part D MTM benefit.

Clinical Pharmacy Services

Specific to clinical pharmacy services, the law provides for:

MTM Grant Programs: The new law establishes a stand-alone grant program to provide pharmacist-provided MTM services as defined by the pharmacy profession’s consensus definition on the Core Elements of an MTM Program. The program ensures testing of practice and care delivery models, such as patient-centered self-management programs, that improve patient outcomes through team-based collaboration between prescribers and pharmacists.

Integrated Care Models: The law also includes provisions to ensure that providers with expertise in pharmacotherapy, including pharmacists, are fully engaged in integrated, collaborative, team-based approaches to delivering care, including medical homes, accountable care organizations, community health teams, and home-based chronic care programs.

Transitional Care Activities: The law recognizes the gaps in care coordination and communication that often occur when patients are transferred from one setting of care to another. Problems arising from inappropriate medication use are a primary reason for hospital readmissions. Pharmacists, helping to manage pharmacotherapy as part of a transitional care team, will be able to play major roles in preventing these events. Transitional care activities might include medication reconciliation, improved use of personal medication records, and discharge planning that may include MTM services.

Medicare Advantage Plan Incentives: The law provides bonus payments to Medicare Advantage plans that conduct care coordination and management activities. In particular, it acknowledges the need for MTM programs to address medication use issues such as poly-pharmacy through medication reconciliation, periodic reviews of drug regimens, and integration of medical and pharmacy care for chronically ill, high-cost beneficiaries.

Workforce: The law establishes a National Health Care Workforce Commission that will study health care workforce supply issues and make recommendations back to Congress.

Next Steps

The inclusion of these provisions in the final law represents a formal recognition at the federal level that MTM is a vital component of the nation’s health care reform initiative and a recognition of pharmacists as health professionals uniquely qualified to deliver these services as members of the health care team.

This recognition is the result of an ongoing, profession-wide effort to educate lawmakers, advocate for expanded access to pharmacists’ services, and draw attention to the issue of medication use.

Even before the bill was signed into law, ACCP and our pharmacy stakeholder colleagues had initiated discussions with key leaders in Congress and the administration regarding the scope and structure of the clinical pharmacy provisions outlined in the legislation.

These discussions included meetings with congressional appropriators, who ultimately determine the funding of the provisions; outreach to the administration officials in Health and Human Services (HHS) agencies who will administer the programs; and ongoing participation in the Patient-Centered Primary Care Collaborative (PCPCC). PCPCC is a coalition of more than 500 major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, and clinicians who have joined together to develop and advance the patient-centered medical home (PCMH). PCPCC is considered the primary work group for the development of the PCMH.

How You Can Get Involved

ACCP’s Legislative Action Center contains a wealth of information about your elected officials and allows you to communicate with your members of Congress.

Remember, to maximize your impact, you are encouraged to edit and personalize the letter, providing background on your practice and professional experience.

In addition, you are strongly encouraged to make the following requests in your letter:

Ask for a list of the dates your members of Congress will be available for meetings in their district or state.
Ask about any “Town Hall” meetings your members of Congress have scheduled, particularly those focused on health issues.
Request an in-person meeting with your members of Congress and/or staff while they are home for the recess.

Invite your legislators to tour your practice setting

Perhaps the single greatest challenge facing the pharmacy community in Washington is the enduring perception that pharmacists are drug dispensers who do not play a role in patient care. The most effective step an ACCP member can take to help members of Congress understand the differences between traditional retail pharmacy and the patient care services provided by a clinical pharmacy is to invite members to tour a practice setting and to see firsthand what clinical pharmacy is all about.

ACCP has prepared a guide to help you reach out to members of Congress and schedule a visit. We have even drafted a letter you can send directly from the Legislative Action Center inviting your federal officials to tour your facility.

Click here to visit the site and send a letter yourself!

NOTE – Please be certain to secure the necessary approval from your organization before requesting that members of Congress tour your practice setting.

Please also be sure to work closely with ACCP staff in Washington to ensure that your practice tour is as effective as possible. We can help you prepare for the event and coordinate follow-up activities.

Contact John McGlew at (202) 621-1820 or [email protected] to discuss how to conduct a successful meeting with a lawmaker and how to maximize your political impact with that lawmaker.

ACCP Political Action Committee (PAC)

ACCP’s 2007 Strategic Plan called for an examination of the feasibility and value of establishing an ACCP Political Action Committee (PAC).

Based on research conducted by staff and outreach to ACCP membership, the ACCP Board of Regents at its February 2010 meeting approved the establishment of a PAC to support and advance ACCP’s advocacy agenda in Washington, DC.

What is a Political Action Committee (PAC)?

A PAC is a legally defined entity organized to help elect political candidates.
PACs must report all financial activities, including direct donations and other expenses, to the Federal Election Commission (FEC), which makes the reports available to the public.

Why Establish a PAC?

A PAC is the only means by which ACCP can provide financial support to help elect pro-pharmacy candidates.
Political contributions help raise our profile in Washington, DC.
Attending fundraising events offers an opportunity to secure face time with members of Congress or congressional staff.
ACCP members can also attend events on behalf of the College and help improve their relationships with elected officials.

Why Support Your PAC?

The success of the ACCP PAC depends entirely on the support of ACCP members. Although we recognize the commitment that ACCP members already make to the College and other professional organizations, this is clinical pharmacy’s PAC, which presents a unique opportunity to raise our political profile and advance our advocacy agenda.

ACCP will roll out a newly launched PAC during the coming months. Watch for further updates on how you can get involved in this exciting venture.

ACCP/ASHP/VCU Pharmacy Policy Fellow Program

In 2006, ACCP, together with the Virginia Commonwealth University (VCU) School of Pharmacy and the American Society of Health-System Pharmacists (ASHP), established the country’s first Pharmacy Healthcare Policy Fellow program.

Under the leadership of Gary R. Matzke, Pharm.D., of the VCU School of Pharmacy, Ed Webb, Pharm.D., MPH, of ACCP, and Brian Meyer of ASHP, the program was developed to provide active learning in multiple policy environments.

The initial month of the program consists of an orientation curriculum put on by faculty of the VCU School of Pharmacy and the government affairs staff of ACCP and ASHP. Fellows then spend 1 year working as special assistants/fellows on 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 will be actively mentored during his/her development of legislative evaluation and policy development skills as well as research and writing skills as he or she integrates practical policy experience with theory.

The Fellow will also be 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 (HHS) for 6 months, followed by almost 6 months in the office of Senator Joseph I. Lieberman (Independent-Connecticut).

Dr. Neyarapally went on to be 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 U.S. Food and Drug Administration (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 and dog to Washington, DC. Dr. Legreid Dopp also worked on health care issues in the office of Senator Joseph I. Lieberman. Anna returned to Wisconsin with her husband, John, and baby, Krista where she remains engaged in health policy and patient care.

Anna recently accepted a position with the WEA Trust, a not-for-profit health plan providing coverage for Wisconsin public school employees and their families. Anna also provides patient care services at a federally-qualified-health-plan in Wisconsin and is pursuing additional post graduate studies.

2008–2010. The 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. Dr. Hammonds currently serves under HELP Committee Chair Tom Harkin (D-IA).

Applications for the 2010–2011 Pharmacy Healthcare Policy Fellow Program
Interested candidates should visit the Pharmacy Healthcare Policy Fellow program’s website for more information and instructions on submitting an application.

ACCP’s New Address in Washington

As a reminder, ACCP’s Washington office has moved. Our new address is as follows: