CONTRIBUTOR
Michael Myser
Essential Insights contributor, healthcare writer
Featured expert
Brad Tice, RPh, PharmD, MBA, FAPhA
Director, Product Strategy and Commercialization
Cardinal Health
Brad Tice has spent nearly 25 years of his career implementing clinical services within retail pharmacy settings. As the healthcare market evolves to a value-based care model that pays for quality and performance, his experience sheds light on how community pharmacies can thrive amidst these changes.
Now the director of product strategy and commercialization for Cardinal Health, and incoming president-elect of the American Pharmacists Association, Tice sees the changing healthcare landscape as an opportunity for community pharmacists to not only expand their businesses, but also practice at the top of their licenses.
October is American Pharmacists Month, and Tice used the occasion to speak with Essential Insights contributor Michael Myser about opportunities and challenges for community pharmacies, and how pharmacy practice must evolve in our changing healthcare market.
Myser: What big changes are pharmacies dealing with in this new age of healthcare?
Tice: Probably the biggest change community pharmacies are facing is the establishment of performance provider networks and the narrowing of these networks, where health plans are giving their beneficiaries access to a more select network of pharmacies.
Until recently, health plans wanted to have broad coverage with as many pharmacies as possible. But now there's this focus on value-based care rather than fee-for-service models, so health plans are contracting with fewer pharmacies — particularly those that can prove they are addressing quality measures, delivering care that's improving the lives of patients, and reducing the overall total cost of care.
Myser: Do you see these changes as opportunities or challenges for pharmacies?
Myser: What opportunities do you see for pharmacies?
Tice: There is an opportunity to make real practice change in the pharmacy, and find new revenue streams beyond dispensing medications. We started with the concept of "pharmaceutical care" back in the 90s, where pharmacists implemented clinical programs around what is now called "medication therapy management" (MTM). Then, MTM was later incorporated into Medicare Part D.
So pharmacies need to continue to build on this concept – working closer with patients to better meet their health needs, and not just dispensing their medications.
Clinical collaboration - and the capability of allowing pharmacists, doctors and patients to communicate effectively in real-time - is expected to be a larger part of pharmacy practice as the model evolves.
Myser: What do you see as the first step - or second or third - pharmacies can make to evolve their pharmacy practice?
Tice: Pharmacists must move from a prescription focus to a patient focus. Offering an immunization program is a good first start, in large part because there's already a business model around it and it's a pretty well accepted practice these days.
After that, medication synchronization is a core service pharmacies should think about. When a patient has five to 12 medicines they're taking each day, you can align these refills so the patient can consolidate their visits to pick these up. Plus, the advantage of medication synchronization is that it also provides an opportunity to create an appointment-based model where pharmacists not only review medications, but engage with the patient and offer other services. Do they need a flu shot? Do they need their A1C (blood glucose) checked?
Pharmacists must change their mindset beyond just filling prescriptions and move to a patient-centered view where they are looking at all of the patient’s needs when they fill prescriptions. Each prescription fill/refill provides an opportunity to more meaningfully engage the patient.
Myser: What will happen to pharmacies that don't start evolving to meet these demands?
Myser: Congratulations, you were recently elected to take over as president of the American Pharmacists Association (APhA). What initiatives will the association be tackling to assist its members moving forward?
Tice: Thank you. I officially become president-elect in March 2018 and first and foremost, we need achieve provider status for pharmacists at the federal level (getting recognition for the patient care services provided by pharmacists so they can be reimbursed by programs like Medicare Part D). We're getting great support for this, but we need to get legislation passed. [Editor's note: Both the U.S. House of Representatives and U.S. Senate have bills in process this legislative session. APhA has more details on provider status legislative efforts on their website.]
Two, we need to get to work on the infrastructure to help pharmacists implement these practice changes. There's a need to get pharmacists credentialed to be in these provider networks so that health plans understand they're eligible, just like a physician. There's also work being done to get a solid billing infrastructure in place.
One of our other goals is to increase the membership of APhA. We led the way on immunization practice in the pharmacy, and we're leading the way on provider status. The more members we have, the bigger voice we can have and the easier it is to make those changes happen.
Myser: Why do you believe it is so critical to achieve provider status for pharmacists?
Tice: The goal of provider status is to enable the pharmacist to practice at the top of his or her license. Pharmacists are trained for six or seven years on appropriate medication use, but they do so much more than just counting pills, putting them in a bottle, and handing them across the counter. Pharmacists make sure patients are on the right medications, are using them the right way, and achieving the desired results with those medications.
Getting provider status passed, and building an effective infrastructure will give pharmacists the ability to use everything in their arsenal to improve patient care.
More and more, we see patients needing access to more comprehensive services. The consequences of suboptimal medication use are astounding -- from hospitalizations, to readmissions, to even death.
I look forward to helping more pharmacists provide quality patient care services and improve the health, wellness, and quality of life for those we serve.