Pharmacists Getting Paid Through Collaborative Clinical Services

1.1 Navigating the Opportunity of Team-based Care

At the completion of this activity, participants will be able to:

• Articulate the value of pharmacists’ impact on each component of healthcare aims.
• Describe the approach for pharmacist-led collaborative clinical services for an independent medical practice, federally-qualified health center or rural health center, and an accountable care organization.

1.2 Introduction to Medical Provider Quality Measures

At the completion of this activity, participants will be able to:

• Explain how a pharmacist can impact quality measures within value-based care.
• Discuss the benefits of being knowledgeable about provider quality measures.

1.3 The Quality Payment Program

At the completion of this activity, participants will be able to:

• Discuss eligibility for the different programs encompassed within the Quality Payment Program (QPP).
• Outline the components and their impact on the Merit-Based Incentive Payment System (MIPS) final score.

1.4 Navigating Quality Performance in the Practice Setting

At the completion of this activity, participants will be able to:

• Recognize the relationship between practice performance and payment adjustments for different models within value-based payment.

2.1 Pharmacist Population Health Managements

At the completion of this activity, participants will be able to:

• Describe the ways that a pharmacist can optimize medication use and disease state management within the setting of a medical practice.
• Explain how a pharmacist is trained to address gaps in care, such as immunizations and other preventive care needs.
• Discuss the resolution of social determinants of health (SDOH) with the impact on patient care.

2.2 Navigating the Rules of Collaboration

At the completion of this activity, participants will be able to:

• Classify the role of the pharmacist in the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) definitions.
• Explain the difference between the rules and requirements for direct supervision and general supervision.

3.1 The Annual Wellness Visit (AWV)

At the completion of this activity, participants will be able to:

• Compare the eligibility requirements for the initial Annual Wellness Visit (AWV) and subsequent AWVs.
• Distinguish the required components of an AWV.
• Deduce appropriate add-on services for the AWV.

3.2 Chronic Care Management (CCM) and Principal Care Management (PCM)

At the completion of this activity, participants will be able to:

• Distinguish patient qualification for Chronic Care Management (CCM) and Principal Care Management (PCM) services based on specific diagnoses.
• Evaluate if all patient consent requirements are met for CCM and PCM services.
• Categorize activities that qualify as CCM clinical staff time.
• Differentiate between the requirements for complex and non-complex CCM.

3.3 Remote Physiologic Monitoring (RPM)

At the completion of this activity, participants will be able to:

• Determine patient qualification for remote physiologic monitoring services based on specific diagnosis codes and disease state control.
• Evaluate the required components of RPM.
• Select an appropriate device for RPM based on a clinical scenario.

3.4 Behavioral Health Integration (BHI)

At the completion of this activity, participants will be able to:

• Distinguish patient qualification for Behavioral Health Integration (BHI) services.
• Evaluate the required components of BHI.
• Select an appropriate validated screening tool for a patient based on a specific behavioral health condition.

4.1 The Collaborative Relationship

At the completion of this activity, participants will be able to:

• Compare the eligibility requirements for the initial Annual Wellness Visit (AWV) and subsequent AWVs.
• Discuss key considerations for creating a sustainable financial arrangement.

4.2 Medical Billing and Coding

At the completion of this activity, participants will be able to:

• Evaluate a medical claim, including the date of service, procedure codes, number of units, modifiers, and diagnosis codes.
• Illustrate the medical billing cycle.
• Explain how to address billing rejections by navigating remark codes from the remittance advice.

5.1 The Value Proposition for Pharmacist Collaboration

At the completion of this activity, participants will be able to

• Describe the components to include in a 1–2-minute pitch to a medical provider and care management team, advocating for the role and the value of the pharmacist in a collaborative model of care.
• Describe a pilot proposition for pharmacist-led collaborative clinical services that specifies service set, proposed patient targets, and duration.

5.2 Evaluating the Collaborative Opportunity

At the completion of this activity, participants will be able to:

• Analyze strategies for ensuring internal and external business success for launching collaborative clinical services.
• Evaluate the financial opportunity for a partnership based on the payer mix, number of patients, and proposed collaborative clinical services.

6.1 The AWV Case

At the completion of this activity, participants will be able to:

• Simulate the role of the pharmacist in conducting an annual wellness visit (AWV), a health risk assessment (HRA), and an appropriate patient interview.
• Devise an appropriate written screening schedule for the next 5–10 years for a patient during the AWV.
• Establish a list of patient risk factors and provide personalized health advice and appropriate referrals to address modifiable risk factors.
• Build a medical claim for an AWV with appropriate procedure codes, modifiers, number of units and diagnosis codes.

6.2 The CCM Case

At the completion of this activity, participants will be able to:

• Outline a chronic care management (CCM) comprehensive care plan.
• Review a monthly log of activities for chronic care management.
• Assess the accuracy of medical claim components for CCM services.

6.3 The RPM Case

At the completion of this activity, participants will be able to:

• Select appropriate platform given a real-world scenario.
• Define medical staff roles.
• Evaluate patient eligibility for RPM services.
• Devise a patient care plan given patient data and RPM protocol.
• Assess the accuracy of medical claim.