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Transformation of Clinical Pharmacy Practice in the VA: Implications for Profession. Anthony P. Morreale, Pharm.D., MBA, BCPS National Director, Clinical Pharmacy Services and Healthcare Services Research. Department of Veterans Affairs Pharmacy Benefits Management. Objectives.
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Transformation of Clinical Pharmacy Practice in the VA: Implications for Profession Anthony P. Morreale, Pharm.D., MBA, BCPS National Director, Clinical Pharmacy Services and Healthcare Services Research. Department of Veterans Affairs Pharmacy Benefits Management
Objectives • Understanding the global goals of the VA Transformation of Ambulatory Care Practice including both primary care and Specialty Care • Become knowledgeable about the strategies that VA PBM has taken to realign current operational and clinical practices to meet these challenges • Create Awareness of the Challenges that exist in meeting these changes • Understand the implications of the VA’s transformation on the practice of Pharmacy and on Healthcare reform
Patient Aligned Care Team • The Patient Aligned Care Team Model is a patient-driven, team-based approach that delivers efficient, comprehensive and continuous care through active communication and coordination of resources. • PACT model puts the relationship with the provider and team at the center of a patient’s care, and has expectations for timely, continuous, patient-centered, and coordinated care.
Key Principles of Medical Home That Teams are Tasked to Meet
VA CPS Scope of Practice Scope of Practice allows CPS to: • Work in concert with an attending physician • Evaluate medication therapy through direct patient care involvement • Prescribe medications, devices and supplies to include: initiation, continuation, discontinuation, monitoring and altering therapy without co-signature • Perform physical measurements necessary to ensure appropriate patient clinical responses to drug therapy • Order consults, as appropriate, to maximize positive drug therapy outcomes and disease state management. • By working with a Scope of practice and not a protocol CPS can adopt practice changes quickly to reflect changes in literature, medication formulary and safety changes as well as new practice guidelines.
Why the CPS is Important to the PACT Team PACT Pillars: Access – yellow Care Coordination – blue Practice Redesign - red
Midlevel Model with CPS : Chronic Disease Manager ModelMid-level Providers provide MTM services to complex patients Complex Medication Therapy Management Provider Clinical Pharmacy Specialist Clinical Pharmacy Specialist
Chronic Disease Medication Management • Chronic diseases have multiple drug therapy options to achieve therapeutic goals. • VA’s National Formulary and PBM/MAP Criteria for Use documents provide patient specific criteria • CPS and Clinical Pharmacists are well versed with the VA National Formulary and are VA experts on drug information, medication selection for specific diseases and medication safety (alerts and bulletins). • CPS have the advanced skills necessary to provide Medication Management Services in Primary Care and Specialty Care • The Clinical Pharmacist plays a vital role in dual-care management, therapeutic interchange, and medication reconciliation
Patient Complexity, Health Status, Needs Medical Home Team Specialty Care Teamlet & Extended Team Clinical Pharmacist Specialist Specialist Clinical Nurse Specialist Clinical Nurse Leader, Case Managers, Clinical Pharmacist Specialist Coordination of Care Disease/Cohort Management Management of Care
Educating Leadership How to Evolve • Technicians • Outpatient Staff • Clinical Staff • Experts • Contractors • Workload Assessment • Innovation • Technology • “Buy vs. Make” • Service Line Budgets
