Edited and compiled by Maureen Thielemans
It’s complicated. To understand managed care pharmacy, you must consider quality, safety, adherence, expenses and other multifaceted elements. The bottom line is that it’s about improving patient health while controlling costs—and teamwork plays a key role.
From patient-centered medical homes to managed care pharmacy rotations, schools are providing faculty with opportunities to learn and to help students participate in these new healthcare organizations. Building on the managed care pharmacy basics we featured in the Fall 2012 issue of Academic Pharmacy Now, we now take a look at how schools are incorporating this complex system into their curricula.
At Texas Tech University Health Sciences Center, student pharmacists are exposed to interesting managed care practices through involvement with local corrections facilities. Since 1995, TTUHSC has been one of two universities in the state to provide healthcare services to offenders housed by the Texas Department of Criminal Justice system. It receives roughly $90 million to cover all medical and dental costs provided to TDCJ inmates at 25 units in west Texas. The School of Pharmacy, which is the only pharmacy program in the state that provides these services, receives approximately $10 million to cover its costs.
Faculty pharmacists review all non-formulary consultations for medications that are not part of the TDCJ list of preferred drugs and conduct Drug Therapy Management clinics at six TDCJ units under protocols written by a physician. At the clinics, three TTUHSC faculty pharmacists see approximately 2,000 patients each year.
Since 1998, up to 35 student pharmacists have worked at these clinics every year as part of the school’s managed care rotation. They conduct one-on-one patient interviews and make therapeutic and monitoring decisions under the supervision of a faculty pharmacist. Asthma/COPD, diabetes, hyperlipidemia, hypertension and anticoagulation disease are among the conditions these students help manage. After seeing a patient, the students write a subjective data/objective data assessment plan (SOAP) statement.
The School of Pharmacy’s managed care rotation also allows students to participate in clinical rounds conducted at TDCJ’s John Montford unit, which is comprised of a 70-bed hospital and a 30-bed long-term care facility. One faculty pharmacist is assigned to the Montford unit rotation and oversees up to 12 students each year. Through this rotation, students work with oncology and cardiac patients, in addition to others with different illnesses. Under preceptor supervision, these students conduct clinical interventions where they help adjust existing treatment regimens, evaluate renal dosing adjustments, suggest therapeutic substitutions, make IV-to-PO switches and undertake formulary management.
The patient-centered medical home plays a critical role in the new models of managed care. Within the PCMH model, patients gain improved access to care delivered by a team that can include pharmacists, physicians, social workers and nurses, all working together effectively.
The University of Maryland Schools of Pharmacy and Medicine are leaders on a PCMH pilot project created by the Maryland Health Care Commission. The pilot is comprised of 53 practices around the state, including one at the university’s Department of Family Medicine. Chair and Professor of Pharmacy Practice and Science Magaly Rodriguez de DiBittner, Pharm.D., saw an opportunity for the School of Pharmacy to be a key a partner in the design of Maryland’s PCMH model, especially when it came to the role of the pharmacist on the collaborative team.
As part of the PCMH, the school is funding Assistant Professor and Pharmacist Kathleen Pincus, Pharm.D., to be on-site for approximately three days a week. She will have direct access to patients and other teammates in patient care. “We know that most patients are on multiple medicines and that a number of errors that occur are due to medications,” Pincus said. “We want to reduce those errors, increase medication adherence, and decrease adverse reactions and incidents of inaccurate dosing.”
Pincus’ integration into the PCMH team creates important evidence-based research on the impact a pharmacist can have on patient outcomes and reduction in the overall cost of care. The success of the PCMH also has the potential to further advance the field of pharmacy’s effort to be recognized for its contributions to primary care—and for pharmacists to be paid for those efforts.
Evaluation of outcomes is critical to determining not only the efficacy of the pharmacist’s position in the PCMH but the pilot project’s success as a whole. The school’s Department of Pharmaceutical Health Services Research has been contracted to evaluate the statewide pilot. Changes in utilization, cost and quality in the PCMH sites will be measured over time and compared to practice sites that are not participating in the demonstration.
At the University of Minnesota students build managed care skills in a different way: Currently, second-year students learn about the professional, economic, historical and public policy aspects of pharmacy and the healthcare system, including anticipated changes in healthcare and the role of pharmacists. They also learn to apply the basic principles of insurance to healthcare and drug benefit programs, and discuss the impact of changes in healthcare on patients, providers, insurers, financers, regulators and corporate purchasers. The school is also working on a new curriculum that will potentially include APPEs in health-systems that operate on the medical home concept.
Corporate visits give students yet another managed care view. Students engage in rotations at Prime Therapeutics, Medica and Express Scripts. Typically, 10 students per year are sent to each company, where they learn about the pharmacy benefit management industry through hands-on experience. They are encouraged to develop critical thinking and writing skills, and are challenged to be independent thinkers and problem-solvers.
The University of Minnesota Academy of Managed Care Pharmacy Student Chapter is also very active. Each of the 11 teams that participated in this year’s Pharmacy and Therapeutics Competition was matched with a local managed care practitioner. Through this mentoring program, students can check out managed care pharmacy earlier in their education and connect with the community.
In 2009, college faculty worked with the university’s health plan, UPlan, to design and launch a medication therapy management benefit available to approximately 37,000 UPlan members statewide. Today, college faculty continue to manage that pharmacist network.
A pair of faculty members at West Virginia University are leading the way for managed care pharmacy at their school. Dr. Gina Baugh, director of Introductory Pharmacy Practice Experiences, educates first-year students on managed care concepts through a two-part lecture focusing on Medicare and Medicaid.
“Managed care is such an integral part of community pharmacy practice,” Baugh said. “It’s important for our students to understand third-party payors so they can educate our patients on what medications are possibly less expensive or can be covered by alternate means.” Baugh also places the students in community practice work sites to complete portions of their course.
Dr. David Elliott, professor and associate chair of the Department of Clinical Pharmacy-Charleston Division, emphasizes to his students the importance of learning managed care pharmacy concepts. “If you are working in a setting other than acute care or pediatrics, you are going to be on the frontline of an older patient’s access to medications,” he said.
Elliott’s geriatrics elective admits up to 15 second- and third-year student pharmacists each year. The course includes discussions about Medicare Part D, other Medicare plans and the importance of managed care. As a pharmacist in the WVU Geriatrics Clinic at Charleston Area Medical Center, Elliott helps his students develop their skills in interacting with managed care plans, particularly with respect to prescription medication access.
“While the students in the clinic don’t compare plans, they work with what the patient currently has to ensure they have the best, as well as most cost-effective, treatment,” he said. “Our patients are between 65 and 101 years of age and usually have multiple medical co-morbidities, therefore they are often taking numerous medications. It’s our job to help their physician determine what works best for their treatment, insurance plan and budget.”
Through these practices and more, students and faculty are working to ensure that all patients can receive the medications they need to improve their health and wellbeing. It’s no small task, but academic pharmacy is up to the challenge.
Maureen Thielemans is Communications Manager at AACP and editor of Academic Pharmacy Now; firstname.lastname@example.org.