The NGA released an issue brief on January

2015, titled “The Expanding Role of Pharma-

cists in a Transformed

Health Care System.”

The report acknowl-

edges that the scope of

practice as allowed by

state laws restrict

pharmacist from serv-

ing at the full extent of

their training and license and encourages

states and private entities to maximize phar-

macy services by classifying them as health

care providers with the state insurance code,

state employee health plans, health infor-

mation exchanges, and Medicaid.

LEFT: A visual representation of an Accountable Care Organization (ACO), a form of team-based

care. This model is patient-centered, requires collaboration between health care professionals,

requires common access to electronic health records, and alignment of payment to outcomes.

Image adapted from: http://www.healthteamworks.org/medical-neighborhood/aco.html

Sodium-glucose co-

transporter 2 (SGLT2) is ex-

pressed in the proximal renal

tubule and responsible for

reabsorption of the majority of

glucose filtered by the kidneys.

The FDA approved two new

drugs in the SGLT2-inhibitor

class of anti-diabetic drugs,

dapagliflozin (Farxiga®) and

empagliflozin (Jardiance®),

which possess distinct ad-

vantages over canagliflozin

(Invokana®). Specifically,

both can be used in patients

with severe hepatic impair-

ment. Jardiance® has the

additional advantage of less

restrictive use in patients with

impaired renal function and

no association of use with inci-

dence of bladder cancer. A

recent controversy has arisen

from manufacturer ads tout-

ing its weight-loss and blood

pressure reduction “claims” as

benefits for use outside its

approved indication.

H.R.4190, a bill presented to the 113th Con-

gress in 2014 to amend title XVIII (Medicare)

of the Social Security Act to cover pharmacist

services, died in committee with 123 co-

sponsors. However, the

effort has gained mo-

mentum and has been

re-introduced under

H.R.592/S.314, both

titled “Pharmacy and

Medically Underserved

Areas Enhancement

Act” in January to the 114th Congress. With all

previous co-sponsors having been re-elected in

this past midterm cycle, H.R.592 and S.314

have gained 83 and 10 sponsors as

of April 2015, respectively.

“Health care experts increasingly

agree that including pharmacists on

chronic care delivery teams can im-

prove care and reduce the costs of

treating chronic illnesses”

FOA 1305, the State Public

Health Actions to Prevent and

Control Diabetes, Heart Dis-

ease, Obesity and Associated

Risk Factors and Promote

School Health, is a cooperative

agreement that is familiar to us

all. We often find ourselves

wondering whether the grants

are being appropriated to sub-

awardees that are of quality and

ability to execute on the desired

deliverables. Two state partners

were recognized at the Ameri-

can Pharmacists Association

(APhA) 2015 Annual Meeting in

San Diego, CA.

Todd D. Sorenson, PharmD

FAPhA (pictured below)

and Baeteena M. Black, DPh

(pictured above) of Minnesota

and Tennessee, respectively,

received national awards for

their excellence in practice and

contribution to the profession

of pharmacy.

The provision of health services to individuals, families, and/or their

communities by at least two health providers who work collaboratively with their patients and

their caregivers – to the extent preferred by each patient – to accomplish shared goals within and

across settings to achieve coordinated, high-quality care.

A team-based care model led by a physi-

cian that coordinates care with other health professionals to provide comprehensive and continu-

ous medical care to patients with the goal of obtaining maximized health outcomes.

A team-based care model based on a group

of coordinated health care providers and/or health systems that provide care to a group of pa-

tients characterized by a payment and care delivery model that ties provider reimbursement to

quality metrics and reductions in the total cost of care for a population of patients.

Quality measures are validated benchmarks often man-

dated by government programs and payers (e.g. CMS) and allows for comparison across organiza-

tions. Quality indicators are used internally to establish a baseline and implement quality im-

provement strategies to improve from baseline. They are not used for external comparisons.

Some quality indicators may become measures if specifications become standardized. Quality

metrics are developed and validated by various organizations including the Agency for Healthcare

Research and Quality (AHRQ), Pharmacy Quality Alliance (PQA), and the National Quality Fo-

rum (NQF).

A system by which all of a patient’s prescriptions are re-

filled on the same day of the month leading to fewer trips to the pharmacy, no need to call in re-

fills, improved medication adherence and pharmacist monitoring. The National Community

Pharmacists Association (NCPA) has developed Simplify My Meds®, a toolkit that guides com-

munity pharmacists in implementing this system.

M any of the activities that are critical to the CDC's mis-

sion and health priorities overlap with crucial roles for

pharmacists, and pharmacists are increasingly being utilized to

achieve CDC goals. Additionally, numerous resources that sup-

port pharmacy practice goals are available from CDC. The CDC

has a recent history of investments in programs that utilize phar-

macists, including those related to HIV/AIDS treatment and pre-

vention, antimicrobial stewardship, chronic disease prevention

and control, smoking cessation, and safe medication use in preg-

nancy. Participants learned more about these topics and how to

access CDC resources that enable pharmacists to contribute to

major public health priorities.

From right to left: CDR Lori Hall, PharmD and LT Jennifer Lind, PharmD MPH, discussed the overlap of CDC health

priorities and pharmacy practice.

The case for integrating pharmacists into team-

based care models, such as ACOs and PCMHs, will

rely on cost-savings and quality improvement - also

known as the value proposition. The Kennedy Phar-

macy Innovation Center was established at the Uni-

versity of South Carolina in 2010 with the mission

of developing innovative, effective patient-centered

care models. From November 1, 2013 – October 31,

2014, patients with chronic diseases such as diabe-

tes, lipid disorders, hypertension, congestive heart

failure, obesity, and polypharmacy were provided

with Comprehensive Medication Management

(CMM) by a pharmacist within a PCMH model. The

upfront investment in pharmacy services led to in-

creased revenue and physician productivity for an

ROI of 3:1. With the addition of quality indicated by

cost avoidance through better chronic disease man-

agement, the ROI is 15:1.

A 2015 systematic review and meta-analysis evaluat-

ing Medication Therapy Management (MTM) ser-

vices on medication-related problems, morbidity,

mortality, quality of life, and health care use, costs,

and harms found wide heterogeneity in populations

and interventions, and inadequate control of con-

founding that precluded an assessment of the out-

comes of interest. Despite this heterogeneity, the

authors found improved medication adherence, med-

ication appropriateness, and medication dosing. A

body of evidence indicates that pharmacists can im-

pact quality metrics while working as part of a mem-

ber of the health care team. As healthcare reimburse-

ment schemes continue to shift from volume-based

models towards quality-based outcomes, the value of

pharmacy grows and the argument to integrate phar-

macy services becomes more compelling. It is im-

portant, however, that these services continue to offer

the “highest quality at the lowest cost.”

1305/1422 Grantee-

Related Poster Sessions

Medication Therapy Management (MTM) in Federally Qualified Health Centers (FQHC): Improving Chronic Disease Outcomes

From March 2014-February 2015, 375 patients from FQHCs in Ohio with uncontrolled diabetes and/or hypertension were enrolled in a pilot study to determine the impact of pharmacist-provided MTM services on efficacy of patient disease management over a six month period of care. The results indicate:

44.8% of patients with uncontrolled diabetes at baseline were at goal, defined as an HbA1c ≤ 9%, within six months

68.6% of patients with uncontrolled hypertension at baseline were at goal, defined as < 140/90, within six months

75 adverse drug events identified

145 potential adverse drug events were detected and remedied

552 instances of clinical pharmacy services documented

The Development and Execution of Hypertension and Diabetes Self-Management Plans for Patients by Engaging Community Pharmacists

From August 2014-June 2015, 67 patients from a suburban Minneapolis, MN community pharmacy with diabetes and/or hypertension, as determined by their medication list, were surveyed to develop a tool that assists pharmacists in the identification and implementation of diabetes self-management programs and standardize communication with primary care physicians. Results indicate:

Need to refine the worksheet survey further for patients

Need to refine evaluation of medication adherence using recognized measures such as Proportion Days Covered (PDC) and Medication Possession Ratio (MPR)

Physicians prefer one-page standardized forms with relevant, patient-specific information that includes the MN Department of Health logo, along with a clear statement on whether prescriber action is requested or not.

As emerging care models such as ACOs and PCMHs continue to gain favor, and health plans push consumers to

make more informed health care choices, a focus develops on health care providers that can provide the best value

in care. These trends are demonstrated by bundled payment plans with incentives based on quality, publishing of

report cards on the quality of care, and pharmacists being among the health care workers being included in these

models. Among the four domains that encompass 33 quality measures for ACOs, including those relating to diabe-

tes management and preventive care, a majority are covered by pharmacy services. Below is a select list of ACO

quality measures.

The purpose of this news-

letter is to promote the

integration of pharmacists

into team-based care initi-

atives by focusing on evi-

dence of their successful

impact on patient out-

comes. Pharmacists

address the “Triple

Aim” of improving

patient

experience, im­

proving population

health, and reducing

per capita costs.

Pharmacy remains

the most under-

utilized and under-

recognized health

care provider, lack-

ing recognition in

federal and state

laws. Today’s phar-

macists are capable

of more than medi-

cation dispensing

and counseling,

which we hope are

high­lighted in these

newsletters.

Thank you for read-

ing this issue of the

newsletter!

If you have any ques-

tions, comments, or

suggestions, please

email:

lfe8@cdc.gov

ACO # Measure title NQF #

Measure steward

Domain: Patient/Caregiver Experience

ACO-1 CAHPS: Getting timely care, appointments, and information 0005 AHRQ

ACO-2 CAHPS: How well your providers communicate 0005 AHRQ

ACO-3 CAHPS: Patients' rating of provider 0005 AHRQ

ACO-4 CAHPS: Access to specialists N/A CMS

ACO-5 CAHPS: Health promotion and education N/A CMS

ACO-6 CAHPS: Shared decision making N/A CMS

ACO-7 CAHPS: Health status/functional status N/A CMS

Domain: care coordination/patient safety

ACO-9 Ambulatory Sensitive conditions admissions: COPD or asthma in older adults

0275 AHRQ

ACO-10 Ambulatory Sensitive conditions admissions: heart failure (HF) 0277 AHRQ

ACO-12 Medication reconciliation 0097 AMA-PCPI/NCQA

Domain: preventive health

ACO-14 Influenza immunization 0041 AMA-PCPI

ACO-15 Pneumococcal vaccination for older adults 0043 NCQA

Domain: at-risk population

ACO-27 Diabetes: hemoglobin A1c poor control 0059 NCQA

ACO-22 through 26

Diabetes all-or-nothing composite: high blood pressure control, LDL-C control, hemoglobin A1c control, tobacco non-use, daily aspirin or antiplatelet therapy

0729 MCM

ACO-28 Controlling high blood pressure 0018 NCQA

ACO-29 Ischemic vascular disease: complete lipid panel and LDL control 0075 NCQA

ACO-30 Ischemic vascular disease: use of aspirin or another antithrombotic 0068 NCQA

ACO-31 Heart failure: beta-blocker therapy for left ventricular systolic dys-function

0083 AMA-PCPI/ACC/AHA

ACO-32 Coronary artery disease: lipid control 0074 AMA-PCPI/ACC/AHA

ACO-33 Coronary artery disease: ACE inhibitor or ARB therapy 0066 AMA-PCPI/ACC/AHA

ACO: Accountable Care Organization; NQF: National Quality Form; CAHPS: Consumer Assessment of Health Plans Survey; AHRQ: Agency for Healthcare Research and Quality; CMS:

Centers for Medicare and Medicaid Services; COPD: Chronic Obstructive Pulmonary Disorder; AMA-PCPI: American Medical Association-Physician Consortium for Performance

Improvement; NCQA: National Committee for Quality Assurance; ACC: American College of Cardiology; AHA: American Heart Association

This issue was brought to you by KINBO LEE, a 4th year pharmacy student at the Uni-versity of Maryland, who was on rotation at the CDC Division of Diabetes Translation from March 23—April 24, 2015. Upon graduation in May 2015, he will serve at Federal Correctional Complex (FCC) Tucson managed by the Federal Bureau of Prisons (BOP) to fulfill his payback obligation with the US Public Health Service. In the short term, he hopes to develop his skills as a clinical pharmacist and later, move into a more regulatory setting.

The Pharmacist Footprint Issue 02 April 2015

EDITOR: Lori Hall, PharmD

Project Officer Division of Diabetes Translation