1. What Does the Future Hold for Pharmacy
What Does the Future Hold for Pharmacy? Being Part of the Solution Health Innovations Meeting Texas Medical Center September 2016
Introduction from NACDS: Kathleen Jaeger and Jason Ausili

2. Linda Garrelts MacLean Clinical Professor and Vice Dean Spokane, WA lmaclean@wsu.edu 509-995-4926
Laying the foundation for the session: Linda Garrelts MacLean
Healthcare delivery is evolving quickly. Trends indicate that teams of multi-disciplinary professionals working together with the goal of achieving positive patient outcomes are developing and will be the norm in the future. Quality will be improved and costs will be decreased as providers work collaboratively to deliver coordinated care. This session will explore trends, review a health-care forecast from 2016 to 2020 and analyze the best practices of pharmacist-delivered care.
Participants in this session will be prepared to:
Elucidate the top 10 emerging health care trends.
Identify barriers to implementing innovative pharmacist care services.
Describe how to overcome potential challenges associated with innovative pharmacy services through the creative use of collaborative drug therapy agreements which support the ability of a pharmacist to function as a provider.
Explain to constituents how the implementation of pharmacist-delivered services which will increase patients' access to primary care.
Advocate for patient’s access to and coverage for quality pharmacist services, a model of care in which the pharmacist practices at the top of his/her education.

3. What Does the Future Hold for Pharmacy: Implications for Colleges and Schools of Pharmacy
Program
Time
Activity
t=0Program
t=0
Introduction: NACDS
Laying the foundation for the session: Linda Garrelts MacLean
Healthcare delivery is evolving quickly. Trends indicate that teams of multi- disciplinary professionals working together with the goal of achieving positive patient outcomes are developing and will be the norm in the future. Quality will be improved and costs will be decreased as providers work collaboratively to deliver coordinated care. This session will explore trends, review a health-care forecast from to 2020 and analyze the best practices of pharmacist-delivered care.
t+5 min
Groups of 3 will consider the following questions and fill out the template provided (trend, who it affects, why is this important).
What are the top 10 emerging healthcare trends?
What are the implications for patients, providers (including pharmacists) and educators?
Interactive discussion about the trends and the forecast for healthcare.
t+ 15 min
Drivers and forces for pharmacy practice transformation
barriers to implementing non-traditional pharmacy service
overcoming potential challenges associated with non-traditional pharmacy services through the creative use of collaborative drug therapy agreements which support the ability of a pharmacist to function as a provider
how will the implementation of pharmacist-delivered services increase patients' access to primary care and why is this important
T+ 20 min
Perspectives from the field as the practice advances:
The Oregon experience
The California approach
NASPA information and resources
t+ 30 min
The Washington experience
Background
Practice
Research
t+ 40 min
Wrap up
Healthcare delivery is evolving quickly. Trends indicate that teams of multi-disciplinary professionals working together with the goal of achieving positive patient outcomes are developing and will be the norm in the future. Quality will be improved and costs will be decreased as providers work collaboratively to deliver coordinated care. This session will explore trends, review a health-care forecast from 2016 to 2020 and analyze the best practices of pharmacist-delivered care.
Groups of 3 will consider the following questions and fill out the template provided (trend, who it affects, why is this important).
What are the implications for patients, providers (including pharmacists) and educators?

4. What are the top 10 emerging healthcare trends?
Who does the trend affect?
What are implications for patients and providers, including pharmacists?
What are the implications for pharmacy education?
t+5 min
Groups of 3 will consider the following questions and fill out the template provided (trend, who it affects, why is this important).
What are the top 10 emerging healthcare trends?
What are the implications for patients, providers (including pharmacists) and educators?
Interactive discussion about the trends and the forecast for healthcare.

5. Drivers and Forces for Pharmacy Practice Transformation
Barriers to implementing innovative pharmacy services?
Strategies to overcome challenges?
t+ 15 min
Drivers and forces for pharmacy practice transformation
barriers to implementing non-traditional pharmacy service
overcoming potential challenges associated with non-traditional pharmacy services through the creative use of collaborative drug therapy agreements which support the ability of a pharmacist to function as a provider
how will the implementation of pharmacist-delivered services increase patients' access to primary care and why is this important

6. Drivers and Forces for Pharmacy Practice Transformation
The Affordable Care Act influence on transformation?
Role of collaborative drug therapy agreements on transformation?
t+ 15 min
Drivers and forces for pharmacy practice transformation
barriers to implementing non-traditional pharmacy service
overcoming potential challenges associated with non-traditional pharmacy services through the creative use of collaborative drug therapy agreements which support the ability of a pharmacist to function as a provider
how will the implementation of pharmacist-delivered services increase patients' access to primary care and why is this important

7. National Perspectives and Practice Advancement
National Alliance of State Pharmacy Associations
NASPA’s Pharmacist Collaborative Practice Agreements: Key Elements for Legislative and Regulatory Authority ( )
Oregon
California
Washingon
T+ 20 min
Perspectives from the field as the practice advances:
The Oregon experience
The California approach
NASPA information and resources

8. National Perspectives and Practice Advancement
American Pharmacists Association
T+ 20 min
Perspectives from the field as the practice advances:
The Oregon experience
The California approach
NASPA information and resources

9. Embracing “Future Practice” Now
Increasing Access to Quality Patient Care in Community Pharmacies for Minor Illnesses in Washington State
t+ 30 min
The Washington experience
Background
Practice
Research
t+ 40 min
Wrap up
PROJECT TITLE: INCREASE ACCESS TO QUALITY PATIENT CARE IN COMMUNITY PHARMACIES FOR MINOR ILLNESSES IN WASHINGTON STATE
Objective: As states implement the Triple Aim and seek to ensure access to quality care, innovative delivery models are being evaluated on the premise that improved access to care for patients in sites such as community pharmacies will result in more rapid assessment and initiation of therapy, thus improving patient health outcomes. Thus, our research team will complete a 3-phase analysis that will assess feasibility and compare care provided by clinical community pharmacists for 20 minor ailments and conditions with care received in other care settings: physician offices, urgent care clinics, and emergency departments. Comparisons will be made in performance on quality of care indicators per ailment (adherence to clinical practice guidelines), costs per episode (based on initial claim plus any claims for same condition for 30-days), and frequency of follow-up care for the same condition within 30 days (an indicator of inadequate management at the initial visit). Phase 1 will consist of the feasibility and implementation stage; Phase 2 will focus on cost comparison across the different care settings, and Phase 3 will examine health outcomes between pharmacist-provided care and that of other health care providers by examining the quality of care provided.
Comparisons will be made for care provided for the following ailments:
Bronchospasm, wheezing, shortness of breath from asthma or COPD
Animal Bite (Human, Dog, or Cat)
Eye or nasal symptoms from seasonal allergies or other allergic conditions
Herpes virus infections (cold sores, genital herpes, shingles)
Allergic reactions from bee stings (not anaphylactic)
Acute otitis media
Anaphylactic allergic reactions
Lacerations and abrasions
Nausea and vomiting (not related to motion sickness)
Contraceptive pregnancy prevention
Conjunctivitis
Nausea and vomiting caused by motion sickness
Wound infections from burns
Migraine headaches
Ear infections caused by bacteria
Lack of fluoride for oral health
Diarrhea that occurs while traveling
Uncomplicated urinary tract infections
Vaginal yeast infections
Streptococcal pharyngitis
Partners:
Community pharmacies in eastern Washington, the Vancouver/Portland area, and along the I-5 corridor in western Washington will be recruited to offer pharmacist-provided care for the minor ailments and conditions.
The Health Plan to provide claims data on care episodes as well as matching of claims from the care settings.
Physician Advisory Committee comprised of at least six (6) physicians will provide input on protocols and other aspects of the research design.
Assumptions:
Refresher training will be provided to pharmacists and required materials will be coordinated through the Washington State Pharmacy Association’s Clinical Community Pharmacist Training Program. This will assist with standardization of protocol.
Implementation and operation costs will be available from the community pharmacy partners to perform consolidated averages for business analysis of feasibility and sustainability (see measures below).
Sufficient community pharmacy patients will consent to participate to allow matching to Health Plan claims for the same conditions and ailments treated in other care settings.
Sufficient per-enrollee claims data will be available from the Health Plan for each of the physician office, urgent care clinic, and emergency department care settings and for many, if not all, ailments and conditions to perform analyses with sufficient statistical power to detect superiority in costs of care (lower costs) in pharmacist-run sites versus other settings, and equivalence among settings for quality of care.
Per-enrollee claims data will be aggregated by the Health Plan into care episodes that include allowed payments for initial and follow-up visits for 30 days for the same condition, pharmaceuticals, and ancillary tests.
Per-enrollee claims data from the Health Plan will include patient demographic information to allow for multivariable matching of claims from the various care settings.
After a sufficient number of episodes (see sample size estimates below) are identified in which the 20 ailments and conditions are treated first in pharmacist-run community pharmacy sites, the Health Plan will match these episodes with other episodes in which these conditions were treated first in physician offices, urgent care clinics, or emergency departments.
A Physician Advisory Committee will provide technical input throughout the process, including on the protocols.
DELIVERABLES
Phase 1:
Deliverable: Provide feasibility and sustainability information.
Timeline: At completion of pharmacist patient care sites’ implementation and 9 months of service; following review of protocols with Physician Advisory Committee.
Measures: Training material costs, training labor time, facilities and material costs associated with implementation and ongoing service of care sites, labor time per episode of care, reimbursement per episode of care, number of patients seen by site and by episode of care, and patient demographics (sex, age, insurance coverage).
Phase 2:
Deliverable: Provide superiority analysis of pharmacy site costs versus costs from the alternate care settings
Timeline: At such point in time that 309 patients have been treated for each of the 3-5 most common ailments in the community pharmacy sites.
Measures: See Methods and Study Design
Phase 3:
Deliverable: Provide equivalence analysis among care settings for quality of care of health outcomes per ailment or condition
Timeline: At such point in time that 617 patients have been treated for each of the 3-5 most common ailments in the community pharmacy sites.
Measures: See Methods and Study Design

10. Community Pharmacists Caring for Patients with Minor Ailments and Common Conditions
Objective: As states implement the Triple Aim and seek to ensure access to quality care, innovative delivery models are being evaluated on the premise that improved access to care for patients in sites such as community pharmacies will result in more rapid assessment and initiation of therapy, improving patient health outcomes.
Now: A 3-phase analysis is being undertaken.

11. Minor Ailments and Common Conditions Research
Care being provided in the community pharmacies.
Collaborative drug therapy agreements being used.
Pharmacies participating.
Encounters and documentation.
DELIVERABLES
Phase 1:
Deliverable: Provide feasibility and sustainability information.
Timeline: At completion of pharmacist patient care sites’ implementation and 9 months of service; following review of protocols with Physician Advisory Committee.
Measures: Training material costs, training labor time, facilities and material costs associated with implementation and ongoing service of care sites, labor time per episode of care, reimbursement per episode of care, number of patients seen by site and by episode of care, and patient demographics (sex, age, insurance coverage).
Phase 2:
Deliverable: Provide superiority analysis of pharmacy site costs versus costs from the alternate care settings
Timeline: At such point in time that 309 patients have been treated for each of the 3-5 most common ailments in the community pharmacy sites.
Measures: See Methods and Study Design
Phase 3:
Deliverable: Provide equivalence analysis among care settings for quality of care of health outcomes per ailment or condition
Timeline: At such point in time that 617 patients have been treated for each of the 3-5 most common ailments in the community pharmacy sites.
Measures: See Methods and Study Design
t+ 30 min
The Washington experience
Background
Practice
Research
t+ 40 min
Wrap up
PROJECT TITLE: INCREASE ACCESS TO QUALITY PATIENT CARE IN COMMUNITY PHARMACIES FOR MINOR ILLNESSES IN WASHINGTON STATE
Objective: As states implement the Triple Aim and seek to ensure access to quality care, innovative delivery models are being evaluated on the premise that improved access to care for patients in sites such as community pharmacies will result in more rapid assessment and initiation of therapy, thus improving patient health outcomes. Thus, our research team will complete a 3-phase analysis that will assess feasibility and compare care provided by clinical community pharmacists for 20 minor ailments and conditions with care received in other care settings: physician offices, urgent care clinics, and emergency departments. Comparisons will be made in performance on quality of care indicators per ailment (adherence to clinical practice guidelines), costs per episode (based on initial claim plus any claims for same condition for 30-days), and frequency of follow-up care for the same condition within 30 days (an indicator of inadequate management at the initial visit). Phase 1 will consist of the feasibility and implementation stage; Phase 2 will focus on cost comparison across the different care settings, and Phase 3 will examine health outcomes between pharmacist-provided care and that of other health care providers by examining the quality of care provided.
Comparisons will be made for care provided for the following ailments:
Bronchospasm, wheezing, shortness of breath from asthma or COPD
Animal Bite (Human, Dog, or Cat)
Eye or nasal symptoms from seasonal allergies or other allergic conditions
Herpes virus infections (cold sores, genital herpes, shingles)
Allergic reactions from bee stings (not anaphylactic)
Acute otitis media
Anaphylactic allergic reactions
Lacerations and abrasions
Nausea and vomiting (not related to motion sickness)
Contraceptive pregnancy prevention
Conjunctivitis
Nausea and vomiting caused by motion sickness
Wound infections from burns
Migraine headaches
Ear infections caused by bacteria
Lack of fluoride for oral health
Diarrhea that occurs while traveling
Uncomplicated urinary tract infections
Vaginal yeast infections
Streptococcal pharyngitis
Partners:
Community pharmacies in eastern Washington, the Vancouver/Portland area, and along the I-5 corridor in western Washington will be recruited to offer pharmacist-provided care for the minor ailments and conditions.
The Health Plan to provide claims data on care episodes as well as matching of claims from the care settings.
Physician Advisory Committee comprised of at least six (6) physicians will provide input on protocols and other aspects of the research design.
Assumptions:
Refresher training will be provided to pharmacists and required materials will be coordinated through the Washington State Pharmacy Association’s Clinical Community Pharmacist Training Program. This will assist with standardization of protocol.
Implementation and operation costs will be available from the community pharmacy partners to perform consolidated averages for business analysis of feasibility and sustainability (see measures below).
Sufficient community pharmacy patients will consent to participate to allow matching to Health Plan claims for the same conditions and ailments treated in other care settings.
Sufficient per-enrollee claims data will be available from the Health Plan for each of the physician office, urgent care clinic, and emergency department care settings and for many, if not all, ailments and conditions to perform analyses with sufficient statistical power to detect superiority in costs of care (lower costs) in pharmacist-run sites versus other settings, and equivalence among settings for quality of care.
Per-enrollee claims data will be aggregated by the Health Plan into care episodes that include allowed payments for initial and follow-up visits for 30 days for the same condition, pharmaceuticals, and ancillary tests.
Per-enrollee claims data from the Health Plan will include patient demographic information to allow for multivariable matching of claims from the various care settings.
After a sufficient number of episodes (see sample size estimates below) are identified in which the 20 ailments and conditions are treated first in pharmacist-run community pharmacy sites, the Health Plan will match these episodes with other episodes in which these conditions were treated first in physician offices, urgent care clinics, or emergency departments.
A Physician Advisory Committee will provide technical input throughout the process, including on the protocols.

12. Minor Ailments and Common Conditions Research
Phase One
feasibility and sustainability
Phase Two
cost
Phase Three
quality
DELIVERABLES
Phase 1:
Deliverable: Provide feasibility and sustainability information.
Timeline: At completion of pharmacist patient care sites’ implementation and 9 months of service; following review of protocols with Physician Advisory Committee.
Measures: Training material costs, training labor time, facilities and material costs associated with implementation and ongoing service of care sites, labor time per episode of care, reimbursement per episode of care, number of patients seen by site and by episode of care, and patient demographics (sex, age, insurance coverage).
Phase 2:
Deliverable: Provide superiority analysis of pharmacy site costs versus costs from the alternate care settings
Timeline: At such point in time that 309 patients have been treated for each of the 3-5 most common ailments in the community pharmacy sites.
Measures: See Methods and Study Design
Phase 3:
Deliverable: Provide equivalence analysis among care settings for quality of care of health outcomes per ailment or condition
Timeline: At such point in time that 617 patients have been treated for each of the 3-5 most common ailments in the community pharmacy sites.
Measures: See Methods and Study Design
t+ 30 min
The Washington experience
Background
Practice
Research
t+ 40 min
Wrap up
PROJECT TITLE: INCREASE ACCESS TO QUALITY PATIENT CARE IN COMMUNITY PHARMACIES FOR MINOR ILLNESSES IN WASHINGTON STATE
Objective: As states implement the Triple Aim and seek to ensure access to quality care, innovative delivery models are being evaluated on the premise that improved access to care for patients in sites such as community pharmacies will result in more rapid assessment and initiation of therapy, thus improving patient health outcomes. Thus, our research team will complete a 3-phase analysis that will assess feasibility and compare care provided by clinical community pharmacists for 20 minor ailments and conditions with care received in other care settings: physician offices, urgent care clinics, and emergency departments. Comparisons will be made in performance on quality of care indicators per ailment (adherence to clinical practice guidelines), costs per episode (based on initial claim plus any claims for same condition for 30-days), and frequency of follow-up care for the same condition within 30 days (an indicator of inadequate management at the initial visit). Phase 1 will consist of the feasibility and implementation stage; Phase 2 will focus on cost comparison across the different care settings, and Phase 3 will examine health outcomes between pharmacist-provided care and that of other health care providers by examining the quality of care provided.
Comparisons will be made for care provided for the following ailments:
Bronchospasm, wheezing, shortness of breath from asthma or COPD
Animal Bite (Human, Dog, or Cat)
Eye or nasal symptoms from seasonal allergies or other allergic conditions
Herpes virus infections (cold sores, genital herpes, shingles)
Allergic reactions from bee stings (not anaphylactic)
Acute otitis media
Anaphylactic allergic reactions
Lacerations and abrasions
Nausea and vomiting (not related to motion sickness)
Contraceptive pregnancy prevention
Conjunctivitis
Nausea and vomiting caused by motion sickness
Wound infections from burns
Migraine headaches
Ear infections caused by bacteria
Lack of fluoride for oral health
Diarrhea that occurs while traveling
Uncomplicated urinary tract infections
Vaginal yeast infections
Streptococcal pharyngitis
Partners:
Community pharmacies in eastern Washington, the Vancouver/Portland area, and along the I-5 corridor in western Washington will be recruited to offer pharmacist-provided care for the minor ailments and conditions.
The Health Plan to provide claims data on care episodes as well as matching of claims from the care settings.
Physician Advisory Committee comprised of at least six (6) physicians will provide input on protocols and other aspects of the research design.
Assumptions:
Refresher training will be provided to pharmacists and required materials will be coordinated through the Washington State Pharmacy Association’s Clinical Community Pharmacist Training Program. This will assist with standardization of protocol.
Implementation and operation costs will be available from the community pharmacy partners to perform consolidated averages for business analysis of feasibility and sustainability (see measures below).
Sufficient community pharmacy patients will consent to participate to allow matching to Health Plan claims for the same conditions and ailments treated in other care settings.
Sufficient per-enrollee claims data will be available from the Health Plan for each of the physician office, urgent care clinic, and emergency department care settings and for many, if not all, ailments and conditions to perform analyses with sufficient statistical power to detect superiority in costs of care (lower costs) in pharmacist-run sites versus other settings, and equivalence among settings for quality of care.
Per-enrollee claims data will be aggregated by the Health Plan into care episodes that include allowed payments for initial and follow-up visits for 30 days for the same condition, pharmaceuticals, and ancillary tests.
Per-enrollee claims data from the Health Plan will include patient demographic information to allow for multivariable matching of claims from the various care settings.
After a sufficient number of episodes (see sample size estimates below) are identified in which the 20 ailments and conditions are treated first in pharmacist-run community pharmacy sites, the Health Plan will match these episodes with other episodes in which these conditions were treated first in physician offices, urgent care clinics, or emergency departments.
A Physician Advisory Committee will provide technical input throughout the process, including on the protocols.

13. Pharmacy Education: CREATING FUTURE LEADERS
Creating future leaders for the advancement of pharmacy practice.

14. Used with permission from WSPA
9/16/2018
Questions?
Used with permission from WSPA
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