1. San Diego Right Care-GO Leadership Forum on the Prevention of Heart Attacks and Strokes June 4, 2010 Daniel Cusator, MD, MBARebecca Cupp, RPh Chief Medical Officer VP of Pharmacy Greater Newport PhysiciansRalphs Grocery Company

3.  Disruptive Innovation: ◦ Unexpected new offering through price or quality improvement that turns a market on its head.  Benefit of using Appropriate Skill Level

4.  Physicians  Nurses  Clinical Pharmacists  Physician Assistants  Nurse Practitioners  Medical Assistants  Social Workers  Technicians

5.  Making the case for clinical pharmacists as part of the health care team  Pharmacy profession has been moving from a product- focused to patient-focused practice  The Asheville Project ◦ Recognized as a promising intervention for rapid improvement in C/V Dz  Including pharmacists on the care team can provide better outcomes ◦ Kaiser Permanente (early 1990’s) study: improved survival and decreased hospitalizations ◦ Planas, 2009-Improving BP Control in DM HTN patients ◦ de Oliveria, 2010- MTM ROI $1.29 per $1.00 MTM Costs

7.  IPA Group In-House Pharmacist  Academic Clinic Pharmacist  Community Pharmacist

8.  Imbedded Clinical Pharmacist ◦ Supports Specific Group Practice ◦ Continuum of Care for Practice Population

9. PharmD-MD Collaborative Usual Care Internal Medicine Group – UCSD HTN patients Collaborative Practice Protocol MTMS activities Clinic visits and follow-up phone calls RCI Demonstration Project

10.  Medication Therapy Management Services (MTMS) ◦ Drug therapy initiation and monitoring ◦ Medication dosage adjustments ◦ Physical assessment ◦ Laboratory test review/order ◦ Patient Education  Measurable Outcomes

11.  Standardized Pharmacist Coaching Program ◦ Initial Visit ◦ Follow Up Visits ◦ Documentation

12.  Patient Care Services ◦ Medication Therapy Management ◦ Point-of-Care Testing ◦ Patient Education

13.  Benefits ◦ Accessibility ◦ Familiar and comfortable environment ◦ Convenience  Location  Hours ◦ Measurable Results  Improved Scores