2/20/2019 SETMuPP Practice Transformation Demonstration Project S ustainable E ducation & T raining M odel u nder P harmacist P rovider Reimbursement Renee Robinson PharmD, MSPharm, Tom Wadsworth PharmD, BCPS MPH Associate Clinical Professor Associate Professor Idaho State University College of Pharmacy Idaho State University College of Pharmacy UAA/ISU Doctor of Pharmacy Program UAA/ISU Doctor of Pharmacy Program Anchorage, Alaska Anchorage, Alaska wadsthom@isu.edu robiren2@isu.edu Disclosure We have no relevant financial relationships or commercial interests to disclose in conjunction with this presentation Learning Objectives Pharmacists • Describe current barriers in Alaska that limit patient access to non-dispensing pharmacy services • Explain the overall purpose, mission, vision, and timeline of the SETMuPP demonstration project • Outline the underlying philosophies and values of the SETMuPP demonstration project 1
2/20/2019 Learning Objectives Technicians • Define non-dispensing pharmacy services • Explain the overall purpose, vision, mission, and timeline of the SETMuPP demonstration project • Outline the underlying philosophies and values of the SETMuPP demonstration project 2
2/20/2019 Prescriptive Authority “Scope Creep” ≠ Dispensing Dependent Pharmacist Provider Payment Status Extra Training or Certification 3
2/20/2019 Providing clinical services that are compensated within a fee-for-service construct = Pharmacist Provider Status Credentialed network provider within a health plans major medical benefit Terms • Non-dispensing pharmacy services - MTM - Medicare MTM - Post-Diagnostic Disease State Management - Vaccination - General health maintanence - Other 4
2/20/2019 Pathway to Pharmacist Provider Public Perception Attitudinal Barriers Road to Provider Status 01 02 03 04 Billing Resources Payer Credentialing Pharmacist Billing Federal and State Definition of Provider Literacy and Contracting SETMuPP Practice Transformation Demonstration Project S ustainable E ducation & T raining M odel u nder P harmacist P rovider Reimbursement 5
2/20/2019 Alaska DHSS • Working Group • DPH/CDPHP • Contracted AKPhA UAA/ISU PharmD with AKPhA • Contracted with • Recognize AK DHSS Pharmacist • Design Role SETMuPP • Demonstration • Holds the Project • House Funds CDC Grant • Quarterly DP18-1815 • Reports Reports Quarterly SETMuPP Practice Transformation Demonstration Project S ustainable E ducation & T raining M odel u nder P harmacist P rovider Reimbursement Overall Purpose • Identify barriers in Alaska preventing pharmacist’s from being reimbursed as a medical provider when delivering non-dispensing services • Create and implement resources/tools needed to overcome barriers • Train and compensate pharmacists to bill as a medical provider 6
2/20/2019 SETMuPP Practice Transformation Demonstration Project S ustainable E ducation & T raining M odel u nder P harmacist P rovider Reimbursement Mission Address the gaps in healthcare access across Alaska through sustainable pharmacist provided healthcare services. SETMuPP Practice Transformation Demonstration Project S ustainable E ducation & T raining M odel u nder P harmacist P rovider Reimbursement Vision Develop a practice transformation advocacy and training model that: 1) Advocates for policies and regulations which support reimbursement of pharmacist-billed cognitive services. 2) Supports use of provider mechanisms for pharmacist-billed cognitive services. 3) Provides student and pharmacist training and support to competently and proficiently bill for cognitive services. 7
2/20/2019 Policy Makers Legislation Pharmacist Curriculum Payers Advocacy Reform Patient Demand Overcoming Barriers Guiding Principals Public Perception Training Attitudinal Barriers Professional Development Advocacy Curriculum Reform Road to Provider Status Support 01 02 03 04 Billing Resources Pharmacist Billing Federal and State Payer Credentialing Definition of Provider Literacy and Contracting 8
2/20/2019 SETMuPP Practice Transformation Demonstration Project S ustainable E ducation & T raining M odel u nder P harmacist P rovider Reimbursement • Informed legislative and advocacy - Statute and Regulation review - Engagement of policymakers and payers - Identify needed legislative and regulatory change - Align with AKPhA Legislative effort to engage policy makers and advocate for change • Training and support of practicing pharmacist’s - Resource and readiness evaluations - Training and resource toolkit - Monetary incentive • Education of future pharmacist’s through curriculum change - Didactic – evaluation and management billing - Problem-based learning integration (simulation, note writing, and billing) - Electronic Health Record integration - Experiential practice SETMuPP Practice Transformation Demonstration Project S ustainable E ducation & T raining M odel u nder P harmacist P rovider Reimbursement • Informed legislative and advocacy Statute and Regulation review - - Engagement of policymakers and payers - Identify needed legislative and regulatory change - Align with AKPhA Legislative effort to engage policy makers and advocate for change • Training and support of practicing pharmacist’s Resource and readiness evaluations - - Training and resource toolkit - Monetary incentive • Education of future pharmacist’s through curriculum change - Didactic – evaluation and management billing Problem-based learning integration (simulation, note writing, and billing) - - Electronic Health Record integration - Experiential practice 9
2/20/2019 Statute and Regulation Review • Alaska statute definition of healthcare provider • Alaska statute definition of medical care • Alaska statute definition of pharmaceutical care • 42 CFR 438.12 - Provider Nondiscrimination (Federal) • Alaska Medicaid Eligible Providers – Pharmacist’s 10
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2/20/2019 SETMuPP Practice Transformation Demonstration Project S ustainable E ducation & T raining M odel u nder P harmacist P rovider Reimbursement • Informed legislative and advocacy Statute and Regulation review - - Engagement of policymakers and payers - Identify needed legislative and regulatory change - Align with AKPhA Legislative effort to engage policy makers and advocate for change • Training and support of practicing pharmacist’s Resource and readiness evaluations - - Training and resource toolkit - Monetary incentive • Education of future pharmacist’s through curriculum change - Didactic – evaluation and management billing Problem-based learning integration (simulation, note writing, and billing) - - Electronic Health Record integration - Experiential practice 13
2/20/2019 SETMuPP Practice Transformation Demonstration Project S ustainable E ducation & T raining M odel u nder P harmacist P rovider Reimbursement • Informed legislative and advocacy - Statute and Regulation review - Engagement of policymakers and payers - Identify needed legislative and regulatory change - Align with AKPhA Legislative effort to engage policy makers and advocate for change • Training and support of practicing pharmacist’s - Resource and readiness evaluations - Training and resource toolkit - Monetary incentive • Education of future pharmacist’s through curriculum change - Didactic – evaluation and management billing - Problem-based learning integration (simulation, note writing, and billing) - Electronic Health Record integration - Experiential practice Appeal SETMuPP Incentives Claim Submission Eligible Services & Documentation Credentialing & Contracting Resource Assessment 14
2/20/2019 SETMuPP Practice Transformation Demonstration Project S ustainable E ducation & T raining M odel u nder P harmacist P rovider Reimbursement • Informed legislative and advocacy - Statute and Regulation review - Engagement of policymakers and payers - Identify needed legislative and regulatory change - Align with AKPhA Legislative effort to engage policy makers and advocate for change • Training and support of practicing pharmacist’s - Resource and readiness evaluations - Training and resource toolkit - Monetary incentive • Education of future pharmacist’s through curriculum change - Didactic – evaluation and management billing - Problem-based learning integration (simulation, note writing, and billing) - Electronic Health Record integration - Experiential practice Experiential Education Problem Based Learning Lectures 15
2/20/2019 Timeline Modify Advocacy & Modify Advocacy & Implement Advocacy Statute & Legislative Legislative Plan Legislative Plan & Legislative Plan Review Refine SETMuPP Tool Kit – Develop SETMuPP Tool Kit Modify SETMuPP Tool Establish Stakeholder Community Pharmacy – Community Pharmacy Kit teams Establish 2 nd Community Establish Community Establish 2 nd Site Create SETMuPP Tool Kit Pharmacy Site Pharmacy Site Implement Yr-2 Establish Pilot Site Implement Yr-4 Implement Yr-3 Curriculum Reform Curriculum Reform Curriculum Reform Implement 1 st stage of Curriculum Reform Yr-1 Yr-3 Yr-4 Yr-2 16
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