When the Patient Protection and Affordable Care Act (PL 111-148) was signed into law by President Barack Obama on March 23, 2010, ACCP and the pharmacy community welcomed the widespread recognition of the medication use problems our country faces and the provisions that expand the role of the clinical pharmacist in addressing these problems.

ACCP identified the following areas of particular interest to clinical pharmacy.

MTM Grant Programs

The law establishes a stand-alone grant program to ensure pharmacist-provided MTM services as defined by the pharmacy profession’s consensus definition on the core elements of an MTM program. The program ensures the testing of practice and care delivery models, such as patient-centered self-management programs, that improve patient outcomes through team-based collaborations 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 care setting to another. Problems arising from inappropriate medication use are a primary reason for hospital readmissions. Pharmacists—by helping 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 polypharmacy 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 to Congress.

Six-Month Update

It has only been 6 months since the enactment of this historic law, so it is still far too early to judge whether it has achieved its stated goals. After all, many provisions do not begin to take effect until 2011 at the earliest, with some being phased in as late as 2014.

However, ACCP and our pharmacy colleagues continue to work with the relevant congressional committees and federal agencies to implement and launch the programs authorized by the passage of the health care reform law.

MTM Grant Program

Section 3503 of the Patient Protection and Affordable Care Act called for an MTM grant program that reflects a collaborative, multidisciplinary, interprofessional approach to providing services that “improve[s] the quality of care and reduce[s] overall cost in the treatment” of individuals with chronic illness.

With little specific guidance about the structure and scope of the grant program, the pharmacy community has been working closely with legislators and staff at the Agency for Healthcare Research and Quality (AHRQ) – the federal agency charged with delivering the grant programs.

During a series of meetings, the following research questions were developed to identify the type of evidence necessary to build highly effective MTM services and to facilitate refinements in payer policies to promote the growth of services that benefit patients:

• Determine ways to optimize the effectiveness of MTM services as reflected in overall health outcomes.
• Which patients benefit the most from MTM services, and how do we ensure that these patients receive MTM?
• How do we enhance patient and provider engagement and satisfaction in MTM services?
• What methods and performance measures are useful in evaluating MTM services?

With AHRQ expected to issue a call for proposals (or request for applications) within a competitive grant process, ACCP has called on the agency to support research on a variety of models for MTM services through demonstration projects in a variety of settings with funding that is adequate to ensure a robust test of MTM. Individual demonstration projects will likely require funding in excess of $5 million dollars for a multiyear study, and we believe that four to six distinct projects may be necessary to generate the evidence necessary to guide future policy decisions.

Further refinement of the grant program will be facilitated by compliance of the secretary, with legislative language requiring consultation with experts in the design and implementation of the MTM grant program. ACCP also urged AHRQ to solicit the input of MTM providers and patients, as well as the input of research experts, when designing the grants program.

Our proposal to AHRQ highlights the importance of studying best practices for implementing MTM services and for engaging patients in these services so that pharmacists can be of maximal help to their patients.

Patient-Centered Medical Home

C. Edwin Webb, Pharm.D., MPH, ACCP’s associate executive director, has been working for almost 2 years with the Patient-Centered Primary Care Collaborative (PCPCC) (www.pcpcc.net) to develop resource documents that define the core structures and services of patient-centered medical homes (PCMHs).

Of special note and meaning for clinical pharmacists is the publication of “The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes” (please see http://www.accp.com/docs/positions/misc/CMM%20Resource%20Guide.pdf).

This resource guide provides a descriptive framework for the provision of team-based comprehensive medication management services in the PCMH. Also included in the guide are examples of approaches, evidence of effectiveness, and an understanding of the close alignment between the principles of the PCMH and the purposes and outcomes to be achieved through a comprehensive approach to medication management that is team based and that actively engages the patient in the clinical care and goal-setting processes.

The PCPCC is a 600+ member coalition of health professional societies, clinicians from the principal health care professions, health plans, employer groups, patient care quality organizations, hospitals, and others. This coalition has worked together for more than 3 years, particularly during the health care reform debate in Congress, to define and advocate for comprehensive changes in the way primary care services are structured, coordinated, financed, and delivered.

For more information on ACCP’s work with the PCPCC, visit http://www.accp.com/report/index.aspx?iss=0810&art=9.

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.

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’ve 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 sure 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 follow-up. 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).

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

The ACCP-PAC was formally registered with the Federal Election Commission (FEC) in July 2010, and the PAC Governing Council was established to oversee the PAC. The initial ACCP-PAC Governing Council is composed of the following ACCP members:

The purpose of the ACCP-PAC Governing Council is to provide oversight and strategic input into the operations of the ACCP-PAC, with particular focus on fundraising activities and decisions around which candidates to support. The Council members will sit for a 2-year term, mirroring 2-year congressional cycles.

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 ACCP members already make to the College and other professional organizations, this is clinical pharmacy’s PAC and, as such, presents a unique opportunity to raise our political profile and advance our advocacy agenda.

ACCP/ASHP/VCU Pharmacy Policy Fellow Program

In 2006, ACCP, 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. (VCU School of Pharmacy); Ed Webb, Pharm.D., MPH (ACCP); and Brian Meyer (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 Virginia Commonwealth University 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/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/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 (I-CT).

Dr. Neyarapally then served as a policy scientist in the Pharmaceutical Outcomes Research in the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality (AHRQ) and is presently 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 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, and presently serves on the pharmacy group at the Access Community Health Center, part of the Wisconsin Education Association (WEA) Trust, providing insurance and retirement and investment services to Wisconsin public school employees and their families.

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 because of her strong desire to continue her contribution to the health care reform initiatives overseen by the Senate HELP Committee. Dr. Hammonds presently serves under HELP Committee Chairman Tom Harkin (D-IA).

2010–2011: Joshua P. Lorenz of Columbus, Ohio, has been named the 2010–2011 Congressional Healthcare Policy Fellow. Lorenz earned his Pharm.D. degree in 2009 from Butler University College of Pharmacy and Health Sciences in Indianapolis. While enrolled at Butler, he also earned a master’s of business administration degree. He also recently completed a PGY1 pharmacy practice residency affiliated with The Ohio State University.

Dr. Lorenz will begin his fellowship September 1, spending 1 month with the ASHP government affairs staff and 1 month with the ACCP government and professional affairs staff. In November, he will begin working as a policy fellow on Capitol Hill.

“The program had a dramatic increase in the number of qualified applicants this year,” said Gary R. Matzke, a past ACCP president and the founding director of the fellow program. “The Selection Committee, composed of eight individuals from the sponsoring organizations and past fellows, was delighted with this increased interest by pharmacists in health care policy.”

Applications for 2011–2012 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.

Contact Us!

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
Telephone: (202) 621-1820
Fax: (202) 621-1819
[email protected].