SETMuPP Practice Transformation Demonstration Project S ustainable E - - PDF document

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SETMuPP Practice Transformation Demonstration Project S ustainable E - - PDF document

Sep 22, 2022 548 likes •727 views

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

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Tom Wadsworth PharmD, BCPS

Associate Clinical Professor

Idaho State University College of Pharmacy UAA/ISU Doctor of Pharmacy Program Anchorage, Alaska

wadsthom@isu.edu

Disclosure We have no relevant financial relationships or commercial interests to disclose in conjunction with this presentation

SETMuPP

Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider

Reimbursement

Renee Robinson PharmD, MSPharm, MPH

Associate Professor

Idaho State University College of Pharmacy UAA/ISU Doctor of Pharmacy Program Anchorage, Alaska robiren2@isu.edu

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
  • f the SETMuPP demonstration project
  • Outline the underlying philosophies and values of the

SETMuPP demonstration project

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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

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Prescriptive Authority “Scope Creep” Dispensing Dependent Payment Extra Training or Certification

≠

Pharmacist Provider Status

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Pharmacist Provider Status Providing clinical services that are compensated within a fee-for-service construct 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
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Road to Provider Status

Pathway to Pharmacist Provider

Public Perception

Attitudinal Barriers

Federal and State Definition of Provider Payer Credentialing and Contracting Pharmacist Billing Literacy

01 02 03 04

Billing Resources

SETMuPP

Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider

Reimbursement

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Alaska DHSS

AKPhA

UAA/ISU PharmD

  • DPH/CDPHP
  • Recognize

Pharmacist Role

  • Holds the

CDC Grant DP18-1815

  • Working Group
  • Contracted with

AK DHSS

  • Demonstration

Project

  • Quarterly

Reports

  • Contracted

with AKPhA

  • Design

SETMuPP

  • House Funds
  • Reports

Quarterly

SETMuPP

Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider

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
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SETMuPP

Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider

Reimbursement

Mission

Address the gaps in healthcare access across Alaska through sustainable pharmacist provided healthcare services.

SETMuPP

Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider

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.

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Advocacy

Pharmacist

Payers Legislation

Curriculum Reform

Policy Makers Patient Demand

Road to Provider Status

Overcoming Barriers

Guiding Principals

Public Perception

Attitudinal Barriers Federal and State Definition of Provider Payer Credentialing and Contracting Pharmacist Billing Literacy

01 02 03 04

Billing Resources

Training Curriculum Reform Support Professional Development Advocacy

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SETMuPP

Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider

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

Sustainable Education & Training Model under Pharmacist Provider

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
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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
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SETMuPP

Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider

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
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SETMuPP

Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider

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 Claim Submission Eligible Services & Documentation

Credentialing & Contracting

Resource Assessment

SETMuPP Incentives

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SETMuPP

Practice Transformation Demonstration Project

Sustainable Education & Training Model under Pharmacist Provider

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

Lectures

Problem Based Learning

Experiential Education

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Timeline

Statute & Legislative Review Establish Stakeholder teams Create SETMuPP Tool Kit Establish Pilot Site Implement 1st stage of Curriculum Reform

Yr-1

Implement Advocacy & Legislative Plan Modify SETMuPP Tool Kit Establish 2nd Site Implement Yr-2 Curriculum Reform

Yr-2

Modify Advocacy & Legislative Plan Develop SETMuPP Tool Kit – Community Pharmacy Establish Community Pharmacy Site Implement Yr-3 Curriculum Reform

Yr-3 Yr-4

Modify Advocacy & Legislative Plan Refine SETMuPP Tool Kit – Community Pharmacy Establish 2nd Community Pharmacy Site Implement Yr-4 Curriculum Reform