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Using Our Voice to Ensure Patient Access to Pharmacists’ Clinical Services

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Second General Session Steven T. Simenson 2013–2014 APhA President

Los Angeles, California

The Power of a Strong Voice
“Using Our Voice to Ensure Patient Access to Pharmacists’ Clinical Services”

I would like to thank all of you for giving me this amazing opportunity to serve as the American Pharmacists Association president.  Pharmacy has given me so much: a rewarding and challenging profession, a network of talented and dedicated peers around the country and world, and the opportunity to treat and heal patients.

Thank you also to my family and my colleagues, some of whom are here: my pharmacist wife, Wendy, who has encouraged me, kept me focused, and talked me through some of my wild untested practice-changing ideas; my son, Forrest, and our new daughter-in-law, Karolina, an advanced practice critical care nurse practitioner, who works every day in collaborative team-based care; and my Goodrich partners, colleague pharmacists, residents, student pharmacists, and staff.  They have all contributed, pushed the limits, and reached new milestones for pharmacist-provided patient care.  They would all agree—if it is good for the patient, it is good for our pharmacies.  And some are not here, especially my mom, Cathryn, who has always encouraged me to focus on doing the right thing.  Hi Mom, I wish you were here.  Thank you to my family, friends, and colleagues, who while not here today are all with me every day, and their support means the world to me.

Importantly, thank you to our predecessors.  My career and profession are better for your efforts.  We can only hope to emulate the examples and successes you have achieved.  To my immediate predecessor, Jenelle Sobotka, you have provided endless energy as our profession and Association confront a critical tipping point.  I would like to acknowledge the Association leadership and staff and our peer collaborators here today; I look forward to working with you.  This is a great team of advocates for our profession and for the nation’s patients.

And, finally, I’d like to thank Mark Walberg for his kind introduction as well as unknowingly providing some inspiration for my comments this morning.  Most of us know Mark as the host of the popular PBS television program, Antiques Roadshow.  I feel this makes him uniquely qualified to emcee for a profession whose roots go back 3,000 years.  You may not know that the etymology of the word “pharmacy” dates back to the ancient Greek word “pharmakeia,” the occupation of sorcerers who dispensed potions and poisons and also presided over ritualistic human sacrifices.  

Fortunately, our predecessors have been savvy enough to recognize that change is an integral part of the engine that moves our profession forward.  Even thousands of years later, we recognize that our profession must, unlike an antique, evolve with the changing face of health care.  APhA continues to be part of that evolution.  We have strengthened the role of pharmacists, documented the value pharmacists provide, and made progress toward establishing medication therapy management (MTM) as the norm.  Our profession has transitioned from a focus on making medications to the provision of services that ensure medicines work.

Serving patient needs

This year’s “Know Your Pharmacist” campaign is a good example of the “talk” needed by each of us.  Pharmacists understand their patients’ health needs, and they have the tools to help patients understand, too.  Through this campaign, the Association is providing pharmacists with tools to engage patients.  We’re spreading the wellness message that pharmacists are a resource to get the most out of medications.

I am a practicing pharmacist who has been fortunate to provide services in innovative practice models based in a community pharmacy.  I have implemented practice innovations needed to assume a valued role on the health care team.  We’ve had a challenging journey, with more work to do.  However, perseverance, innovation, and focus on serving the patient’s needs have allowed us to create valuable services within our seven community pharmacy practices.  We are in medical home models, have two-way access to electronic health records, and are providing a variety of MTM, wellness, and prevention services that are valued by our medical colleagues.  These experiences help me better represent the vision of what could be if our advocacy stars align.

APhA’s Highest Priority

Your Association’s leadership has committed significant resources toward ensuring patients have access to your patient care services.  Some call this achieving “provider status.”  We have asked questions and listened.  You told us that this was an important issue for APhA leadership.  Whether it was signatures on a White House petition or resolutions in our House of Delegates, you wanted your Association and profession to address this issue. 

APhA is focused on facilitating the profession’s unified voice with other pharmacy stakeholders as partners.  We are also working with colleagues within medicine, payer, and consumer communities to help them understand and recognize the value pharmacists contribute to meeting quality, cost, and outcomes goals.  We all need to be totally committed to this task.  I am contributing through my organizational activities and every day in the care I provide my patients.  You, too, can do the same.  

APhA is committed to optimizing the medication experience and wellness of our patients.  By working with national and state pharmacy organizations through common principles, we can assure that patients do not continue to experience a lack of access to pharmacists’ patient care services.  By working together with patients, other providers, and payers, we will optimize safe, effective, and appropriate medication use while gaining recognition for the services that make this possible.

About a year ago, Mark Walberg published an article in the Huffington Post in which he described how his experience on the Antiques Roadshow has helped him realize what is “truly valuable.”  He points out that it’s not the $50,000 Stickley armchairs or the $90,000 Tiffany necklaces—but rather, it’s the people and the connections he has made with them.  So, too, have pharmacists come to understand it’s the people, in particular, our patients, who give meaning and value to our work.  We are not just dispensing medicine.  We are dispensing care to our patients.

Yet, we have a challenge.  We want to be recognized as patient-centered care providers aligned with the Joint Commission of Pharmacy Practitioners 2015 Vision for Pharmacy Practice and we want to be valued for that fuller role.  We want to be recognized and accepted by the public, payers, policy makers, and our peers as health care providers who contribute to improving access, quality, and value to health care.  Our message must resonate with the patient—the ultimate beneficiary of our services.  We know the value we provide.  So, how could any reasonable person deny our services to a patient? 

We need to achieve recognition with our patients and with our peers on the health care team.  But, we also need to do so with those footing the bill, such as state and federal governments and the private payer system.  Our performances on the field are critical to this proposition.  We have to educate decision makers, who do not directly receive our services, to see the value we provide to the health system and to the ultimate recipient every day.  Unlike the individuals who unwrap treasures for the appraisers on the Antiques Roadshow, it is we, not the appraisers, who must point out the value of our treasure.  We cannot stand idly by when the average member of Congress stumbles over how to differentiate between a pharmacy and a pharmacist and value something they can’t measure.

While the number of petition signatures warranted a White House response, that is just one small step that we will need to take to attain the recognition we desire.  Individually, we need to do more and better talking.  You need to use your voice to sell what pharmacists can do.  I have used this strategy in my own practice.

Making the “Pitch”

I would like to propose an “elevator pitch” meant to quickly demonstrate our ability to contribute to improved access, quality, and value to health care to individuals we are trying to convince.  These statements are powerful.  They are focused on America’s challenges, our patients’ needs, and the value we alone can bring to health care.  It could be targeted to any of our audiences—but this one is focused on the federal sector because we want pharmacists to be recognized on the list of providers in the Social Security Act, which would allow us to participate in team-based delivery of care and serves as model for other programs.  It goes something like this:

Good morning.  My name is Steve Simenson.  I am a pharmacist from Minnesota.

This morning I am going to talk about the importance of patients having access to pharmacists’ clinical services—it’s a smart spend that pays.

Patients with complex medical conditions benefit from pharmacists’ clinical services.

Published literature and practice-based experience have shown that when pharmacists get involved, overall health care costs go down while quality and patient safety improve.

Unfortunately, Medicare Part B does not recognize pharmacists as a provider to receive payment.

To optimize our health care spending, Medicare must include pharmacists’ collaborative services with other providers.

Pharmacists need to be recognized in Medicare Part B—it’s a smart spend that pays.

Yesterday, my predecessor Jenelle Sobotka said that we need to help ensure pharmacists are the game changers in our health care system, and we cannot do it alone.  I agree and I plan to work this year not just to encourage you to start talking more but to using the resources of the Association to help your voices be heard by our peers, in your communities, and in Washington.

Let’s look at the pitch again.

Good morning.  My name is Steve Simenson.  I am a pharmacist from Minnesota.

Washington needs to hear from real people.  There is a term in Washington for fake grassroots organizations—they call it “Astroturf.”  It is important for your voice to be authentic, offering real-world perspective and connected to a vote.  We are real people, working with very real patients, and understand what is really needed.  It is your strong voice that is going to help this profession and our legacy.

If you have a moment, I want to talk to you about how patients, especially those with complex medical conditions, benefit from pharmacists’ clinical services—it’s a smart spend that pays.

It is important for our message to connect with a broader challenge.  In this case, it’s the nation’s fiscal crisis and continued economic struggles.  While we have some evidence of the cost savings that come with leveraging pharmacists in patient care, we are working to make that point even clearer.  Washington relies on certain economic analysis over others.  The Association is planning a simulated Congressional assessment of the value and costs of including pharmacists on the list of providers in the Social Security Act.

People with complex medical conditions benefit from pharmacists’ clinical services.

Published literature and practice-based experience have shown that when pharmacists get involved, overall health care costs go down while quality and patient safety improve.

We have built this case over the past decade.  A 2011 Public Health Service report, Improving Patient and Health System Outcomes through Advanced Pharmacy Practice: A Report to the U.S. Surgeon General, supports pharmacists delivering patient care services through collaborative practice agreements as an accepted model of improved health care delivery that can meet growing health care demands in the United States.  The report includes 27 pages of studies that document the value of pharmacists’ services.

In addition, the work conducted by the APhA Foundation provides further support to our case for pharmacist involvement.  The APhA Foundation’s research and innovation efforts continue to incubate patient care improvements and system change.  Over 2,000 participants in the APhA Foundation’s Project IMPACT: Diabetes are receiving patient-centered, team-based care that is improving clinical process and outcome measures.  Quantitative and qualitative project results are expected this summer.  Patient and physician testimonials paint a powerful picture for the value pharmacists are providing to patients every day.

We will pull the best case examples from these reports and projects and add them to our playbook that will allow decision makers to understand and recognize our contributions to a winning team.  While facts and figures are important, it’s the personal stories that grab the heart!  My own opportunities were magnified by our experiences in the APhA Foundation’s earlier Project ImPACT: Hyperlipidemia.

Unfortunately, Medicare Part B does not recognize pharmacists as a provider to receive payment.

To optimize our health care spending, Medicare must include pharmacists’ collaborative services with other providers.

Pharmacists need to be recognized in Medicare Part B—it’s a smart spend that pays.

We have a problem.  Our patients know the care we provide and the value we add to their lives, and other health care providers are beginning to see the same and count on us as key members of the health care team—but payers and policy makers have yet to realize it.  A great change for our profession—and most importantly for our patients—can be made with simple but hard to get tweaks to existing law.

To get the most value for their health care dollars, patients need policy makers to add pharmacists to the list of providers in the Social Security Act.  Patients need pharmacists to be specifically named in any new payment model created within the provisions of the Affordable Care Act, and innovative practice models need to incorporate pharmacists as valued members of the health care team.

These are small changes that would mean big things for our patients and for all of us.  To make those changes a reality, we need your voice.

Today’s standards for pharmacy education require pharmacists to be ready for practice when they graduate.  We polish our skills on the same playing field as all newly graduated health professionals by taking care of patients.  Many pharmacists have proven themselves after a career of taking care of patients.  Experience, knowledge, and skills will and should all play a role in positioning pharmacists on the health care team.  When it is all said and done, it comes down to us.  Pharmacists, who improve patient health outcomes and provide value and cost savings, will be recognized.

About 10 minutes north of here just off the 110 Freeway, you’ll find the Heritage Square Museum.  One of the exhibits is an antique 19th-century drugstore.  It has shelves and shelves of old cures and of course a soda fountain and counter with stools.  As fascinating as it is, it scares me a little.  I know that it has been constructed from old pharmacies that have ceased to do business.  I also know that it shares some of the same features as my own 142-year-old neighborhood pharmacy in Anoka, Minnesota—a history of survival, change, and adaptability.  However, one feature the Heritage Square drugstore doesn’t have, which my pharmacies have, is practicing pharmacists who have the good fortune to be providing services in innovative practice models based in community pharmacies.  We see patients in our pharmacies and in primary care clinics, utilizing health information technology to integrate with other members of the health care team.  Building on the relationships and collaborative practice we have established, I have collected many examples that support the inclusion of pharmacists as valued members of the health care team.  I am still working on complete and adequate valuation of my services, but I know we have a strong case and see progress every day.  It takes a lot of hard work and exploring opportunities, but it can be done.

Conclusion

For a very long time, you have used your voice, just as I have, to serve your practice.  Our legacy is healthier patients.  In order to keep this legacy in a changing and evolving health care system, we need you to use your voice to articulate what pharmacists can do.  If we do so, our legacy will be a healthier nation, stronger profession, and better Association.

As Jenelle said yesterday, the state of our profession is strong because our Association is focused on helping to improve medication use and advance patient care every day.  As president, I look forward to continuing this tradition.  To do so, I need all of you to speak up—we need your voice.  We need to keep walking and talking, and even shouting, until pharmacists are recognized as the health care team member responsible for ensuring optimal medication therapy outcomes for patients.  Are you with us?

In the coming year, I pledge that I will continue to work on building that case, but more importantly, on communicating it to those who need to hear.  I hope you’ll join me.

Thank you for your time.  I look forward to working, walking, and talking with you in the year ahead.

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