1. THE PHARMACIST FOOTPRINT WHERE PHARMACY, DIABETES, AND
PUBLIC HEALTH CROSS PATHS PRESENTED BY KINBO LEE PRECEPTOR DR. LORI
HALL
2. CONTENTS 1.Drug Update: Sodium Glucose Transport subtype 2
(SGLT-2) Inhibitors 2.Legislation and Policy 3.The Pharmacy Value
Proposition 4.The Healthcare Paradigm Shift 5.Summary
3. DRUG UPDATE: SGLT-2 INHIBITORS
4. SGLT-2 INHIBITORS 1. Canagliflozin (Invokana) FDA approval
in March 2013 2. Dapagliflozin (Farxiga) FDA approval on January
2014 3. Empagliflozin (Jardiance) FDA approval in August 2014
5. SGLT-2 INHIBITORS MECHANISM OF ACTION
6. SGLT-2 INHIBITORS DRUG COMPARISON Biguanides Sulfonylureas
Thiazolidinediones Dipeptidyl Peptidase IV Inhibitor Glucagon- Like
Peptide-1 Agonist SGLT-2 Inhibitors Efficacy (HbA1c) High (1-1.5%
decrease) High High Moderate High Moderate Hypoglycemia Risk Low
Moderate Low Low Low Low Weight Neutral / Loss Gain Gain Neutral
Loss Loss Side Effects GI (diarrhea, cramping), vitamin B12
deficiency, lactic acidosis Hypoglycemia Edema, heart failure, bone
fractures Angioedema (rare), urticaria GI (nausea, vomiting,
diarrhea), increased HR Genitourinary infections, polyuria,
dizziness, hypotension Cost Low Low Low High High High
7. SGLT-2 INHIBITORS INVOKANA COMMERCIAL
8. FDA OFFICE OF PRESCRIPTION DRUG PROMOTION (OPDP) 1.
Maintains the FDA Bad Ad program with CME/CE e-learning course
available 2. Raise awareness about misleading prescription drug
promotion and provide an easy way to report this activity 3. Common
violations include: Omitting or downplaying risk Overstating the
effectiveness Promoting uses not addressed in approved labeling
Misleading drug comparisons
9. LEGISLATION AND POLICY
10. LEGISLATION AND POLICY National Governors Association (NGA)
Mission is to share best practices, speak with a collective voice
on national policy, and develop innovative solutions to improve
state government Founded in 1908 with membership consisting of
governors of the 55 states, territories, and commonwealths
Identifies priority issues and deal collectively with matters of
public policy and governance at the state and national level
11. LEGISLATION AND POLICY NGA REPORT
12. LEGISLATION AND POLICY NGA REPORT RECOGNIZES THAT: 1. The
level of education required to practice shifted from a bachelor of
science (B.S.) to a doctor of pharmacy (PharmD) 2. Core
competencies include toxicology, pathophysiology, pharmaceutical
chemistry, pharmacology, disease treatments, and laboratory
training externships also incorporated into programs. 3. Licensure
requires passing of the North American Pharmacist Licensure
Examination (NAPLEX) and a another exam (e.g. Multistate Pharmacy
Jurisprudence Examination) to test pharmacy jurisprudence knowledge
4. Pharmacists can become board certified in six specialties:
nutrition support, nuclear pharmacy, pharmacotherapy, oncology,
psychiatric pharmacy, and ambulatory care
13. LEGISLATION AND POLICY NGA REPORT FOUR PRIMARY DOMAINS: 1.
Ensuring appropriate medication therapy and outcomes 2. Dispensing
medications and devices 3. Engaging in health promotion and disease
prevention 4. Engaging in health systems management
14. LEGISLATION AND POLICY US. CONGRESS
15. LEGISLATION AND POLICY US. CONGRESS
16. THE PHARMACY VALUE PROPOSITION
17. THE PHARMACIST VALUE PROPOSITION 1. Increase access to care
2. Increase quality of and satisfaction with care 3. Reduce
costs
18. THE PHARMACIST VALUE PROPOSITION
19. THE PHARMACIST VALUE PROPOSITION
20. THE PHARMACIST VALUE PROPOSITION
21. THE PHARMACY VALUE PROPOSITION Kennedy Pharmacy Innovation
Center Established at the University of South Carolina in 2010
Fosters creativity and innovation by connecting passionate,
forward-thinking individuals Develops and supports entrepreneurial
programs, and exploration of new sustainable business models
Transforms pharmacy practice into viable, effective
patient-centered care models by providing tools, resources, and
relationships
22. THE PHARMACY VALUE PROPOSITION Collaborative
Patient-Centered Medical Home (PCMH) Case Objective: Develop and
evaluate sustainable business model for pharmacists providing
comprehensive medication management Focus: Patients with diabetes,
lipid disorders, hypertension, congestive heart failure, obesity,
and polypharmacy Location: Palmetto Primary Care Physicians,
Charleston, SC Time: November 1, 2013 October 31, 2014 Value
Proposition: Revenue, Quality, Satisfaction, Cost Avoidance,
Provider Productivity, and ROI
23. THE PHARMACY VALUE PROPOSITION (CONT.) Key Activities
Obtain and evaluate patient history Assess/manage medication
therapeutic regimens of chronic conditions within treatment
guidelines Provide patient counseling on medications, nutrition,
lifestyle, and medication self-management Conduct limited physical
examinations per guidelines for management of medication regimens
Order diagnostic tests and medical devices to support chronic
disease management
24. THE PHARMACY VALUE PROPOSITION (CONT.) Revenue Streams
Comprehensive Medication Management Incident to Annual Wellness
Visit Chronic Care Management Transitional Care Management Pay for
Performance
25. THE PHARMACY VALUE PROPOSITION (CONT.)
26. THE PHARMACY VALUE PROPOSITION (CONT.)
27. THE PHARMACY VALUE PROPOSITION (CONT.)
28. THE PHARMACY VALUE PROPOSITION (CONT.)
29. THE PHARMACY VALUE PROPOSITION (CONT.)
30. THE PHARMACY VALUE PROPOSITION (CONT.)
31. THE PHARMACY VALUE PROPOSITION (CONT.)
32. THE HEALTHCARE PARADIGM SHIFT
33. THE HEALTHCARE PARADIGM SHIFT 1. Better coordination of
health care among providers 2. Payment incentives for the
coordination of care 3. Use of quality metrics to reward
performance 4. Health care providers responsible for outcomes, not
just the provision of service 5. Report cards to guide consumer
decision-making
34. THE HEALTHCARE PARADIGM SHIFT
35. THE HEALTHCARE PARADIGM SHIFT
36. THE HEALTHCARE PARADIGM SHIFT NGA Center for Best
Practices: Delivery System Reform 1. Care coordination and disease
management (e.g. Accountable Care Organizations) 2. Payment reform
(e.g. CMS, private payers, state Medicaid) 3. Quality improvement
and measurement (e.g. AHRQ) 4. Prevention and primary care efforts
(e.g. immunizations, blood pressure/diabetes screening)
37. THE HEALTHCARE PARADIGM SHIFT The Pharmacists Role in
Team-Based Care Settings Medication management, especially complex
cases Chronic disease management Care transitions Medicare Wellness
Visits Drug therapy consultations Drug information Meeting with
pharmaceutical representatives Examples here and here
38. THE HEALTHCARE PARADIGM SHIFT AN EXAMPLE Centers for
Medicare & Medicaid Services (CMS) ACO Initiatives 1. The
Pioneer ACO Model 2. The Medicare Shared Savings Program
39. SUMMARY 1. The healthcare system is shifting from
volume-based to value-based payment models 2. The mission of the
pharmacist is to provide pharmaceutical care, which is the
provision of medication-related care for the purpose of achieving
definite outcomes that improve patients quality of life 3.
Pharmacists are among the most accessible and trusted health care
professionals 4. Barriers exist in federal and state laws that
limit the pharmacists scope of practice