Advancing as One: The Pharmacy Family is on the Move

Matthew C. Osterhaus, 2014–2015 APhA President, speaks during the APhA2015 Opening General Session in San Diego, CA.

It has been a tremendous honor to serve as your APhA President.  I have met so many wonderful colleagues across the country and around the world, witnessed the energy and enthusiasm pharmacists bring to their practices every day, and have seen the pharmacy family move forward together.  It has been a great ride, made possible by many of you here today.

I would like to begin by thanking my family, friends and Iowa colleagues.  Any success I have had is due to what this extended pharmacy family has given me.  I'll start with the many Iowa pharmacists who have supported me over the past decades: the Iowa Pharmacy Association and its members; Outcomes MTM and Pharmacists Mutual who have helped create an environment in Iowa that defines the term progressive pharmacy practice; my staff at the Osterhaus Pharmacy; my family spread across the country and around the world; my parents, Ann and Bob Osterhaus, who inspire me daily to live life to its fullest; and, finally, my wife, life partner, and personal pharmacist, Marilyn.  Words cannot express my gratitude for the sacrifices you have made and the support you have given me, our family and our practice. 

The victories we have enjoyed as an Association can be attributed to our committed staff, leadership, and membership who work hard and focus on making a difference in the lives of patients. 

You have met my fellow trustees this morning.  They have walked the walk in leading this association to new heights.  They bring a diverse set of practice and life experiences to a board table where everyone's voice is heard.  The inclusiveness of our board reflects the inclusiveness of our pharmacist family and the way we come together to solve problems for our communities and our country.  It has been a pleasure to serve with all of you.

Our members are our lifeblood, representing the profession where it really matters: at the level of our patients, our practices, our schools and as leaders of our communities.  We are a caring profession, and it shows in the way we solve problems and make a difference in the lives of so many every day.  It has been a joy for me to witness this first hand across this country.

This is a significant year in the Osterhaus family history – 50 years ago the Osterhaus Pharmacy was established, and 23 years ago, in San Diego, my dad presided over the APhA Annual Meeting as President (no we didn’t plan this).  Last year I quoted my father’s APhA presidential speech in talking about the “pharmacy family” controlling its own destiny.  I know, after a year as APhA president, that the pharmacy family is flourishing.  Each of you has had a hand in making that a reality.  And each of you controls your own and the profession’s destiny.  You make a difference when you administer an immunization or mentor a student pharmacist.  Every time you go the extra mile to coach a patient with diabetes or collaborate with another member of patients’ health care teams, you control those destinies.  And, every time you send an email to your member of congress, you take our destiny into your hands.  Thanks to you, and thousands of volunteers who give their time every year, the state of our Association is strong.

Like any nurturing family, we become stronger by working through challenges together, supporting each other and taking mutual responsibility for meeting our personal and professional goals.  That is what makes APhA unique: we thrive on the diversity of our membership and by sharing our insights with each other to improve the lives of our patients.

Advancing as One

During the holidays we have a family tradition of having a puzzle table in the living room at my parent’s house.  As family members walk by, they add a piece or 2 in the right place.  Some members are more engaged than others – but by the end of the holidays we have accomplished our goal and the picture is complete.  The scenario is similar in our profession; we all have a role to play in making our profession complete.  It takes a team effort to get there, and you as an individual can choose how active a role you wish to play.  But if we want the big picture to be complete, everyone needs to pitch in.

Throughout my presidential year we have focused on connecting individual puzzle pieces to “Advance As One” on behalf of the patients we affect and care for, through a unified:

  • Profession
  • Association
  • Health Care Team, and
  • Patient Care Process

Here’s how we are doing that.  The Association has led the advance in helping us all put the puzzle together.  And on each of those fronts, we have made measurable progress this year.  

Advancing as One:  Unified Profession

We are advancing as one profession.  But towards what?  We know what the puzzle looks like.  It remains the Joint Commission of Pharmacy Practitioners (JCPP) Vision Statement:  Patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers within patient centered, team-based healthcare.  As I never tire of pointing out, take note that the patient comes first!

We are putting the pieces together one at a time… and we are collaborating with many others.

We are in the midst of an unprecedented era of collaboration among national and state pharmacy organizations and stakeholders.  APhA’s role has been a convener of stakeholders, communicator of the issues, and builder of consensus so that we are advancing as one.  As a profession, flexibility is vital as we identify opportunities and find ways to integrate pharmacists as a solution.  There is much work to be done by all stakeholders and each contributor deserves appropriate credit.

In 2014, APhA vigorously advocated for the recognition of the value and coverage for pharmacists’ patient care services.  We saw some remarkable success when a provider status bill, H.R. 4190, was introduced in the United States House of Representatives.  The bill enables Medicare Beneficiaries access to pharmacist-provided services under Medicare Part B by amending the Social Security Act.  Pharmacy services would be compensated under Medicare Part B if they are provided in medically underserved communities and consistent with state scope of practice laws.  The provider status bill had broad bipartisan support in the last Congress with more than 120 cosponsors from both sides of the aisle.  The momentum has begun and will continue into the new Congress.

During the last week of January 2015, H.R. 592 and S.314, which both mirror the 2014 H.R. 4190 provisions, were introduced in the US House of Representatives and US Senate, with bipartisan support.  H.R. 592 was introduced by Representatives Brett Guthrie of Kentucky, G.K. Butterfield of North Carolina, Todd Young of Indiana and Ron Kind of Wisconsin.  S. 314 was introduced by Senators Chuck Grassley of Iowa, Robert Casey of Pennsylvania, Mark Kirk of Illinois, and Sherrod Brown of Ohio.  The bills are gaining momentum as the number of cosponsors increases.  Establishing relationships and working with members of Congress that resulted in the bill introductions was done through the efforts of the organizations who make up the Patient Access to Pharmacists’ Care Coalition (PAPCC). 

The PAPCC, in an effort to support decision-maker understanding of the legislation and value of pharmacists’ patient care services, has embarked on a multi-million dollar media initiative for the successful passage of federal provider status legislation.  This work is a great example of our profession advancing as one – look who is engaged in this effort.  These organizations and YOU are the Power of Pharmacy.

Besides federal legislation, we are also continuing our work with CMS and other policymakers on implementation and expansion of Medication Therapy Management.  APhA’s outreach activities and comments have been shaped using feedback gathered from members involved in providing MTM services.  Moving beyond the focus on MTM services as in previous years, this year’s Patient Care Digest, developed and produced by APhA and being released at this meeting, has been expanded to reflect the provision and coverage of all patient care services that pharmacists provide,  Once again this year, the Digest examines the evolving role of pharmacists being integrated as part of the health care teams.

The major impact of our care is at the local level, one patient at a time.  That value has been recognized in a report released by the National Governors Association (NGA), “The Expanding Role of Pharmacists in a Transformed Healthcare System.”  Collaborative efforts by APhA and the National Alliance of State Pharmacy Associations (NASPA) helped inform and guide the paper’s authors that ultimately led it to observe that “Pharmacists have the professional expertise to address key challenges facing the health care system.”  The report also stated that, “Examining state-specific challenges and promising practices from other states will allow states to develop policies that permit pharmacists to practice within the full scope of their professional training across the health care continuum.”

Sharing and highlighting activities at the state level provides the opportunity to innovate and advance patient access to our services in every locale.  Whether it’s new payment and delivery models in Wisconsin and North Carolina, expansion and modification to scope of practice in California, or an Iowa pilot that empowers technicians so pharmacists can provide patient care services, efforts such as these and others promote getting pharmacists in the game in a meaningful way.

In the words of a noted philosopher from North Carolina, Michael Jordan, “talent wins games, but intelligence and teamwork win championships.”  We are winning the opportunity for our patients to gain access to our care.  Let’s win together!  We want to see President Obama sign this legislation!  And the only way we’ll get there is through our collective intelligence and a team effort like we have never seen before.

Advancing as One: Unified Association

APhA works to unify our profession and our membership by bridging varies practice perspectives.  You have helped us create a lot of momentum.  APhA has given you the tools to advocate on behalf of the profession and your own career.  As part of this campaign, APhA developed informational materials and videos to use in advocacy efforts.  To date, APhA’s campaign has more than 16,500 volunteers and 128 videos from 50 states describing the value that pharmacists are providing to patients.

In 2014, APhA worked towards elevating pharmacy practice by reinforcing the value of pharmacists’ services, helping influence new health care delivery models, advocating for the expansion of MTM, leading a multi-organizational stakeholder group in the creation of a new Pharmacists’ Patient Care process, and expanding our accreditation efforts.

In January, APhA launched a revised PharmacistsProvideCare.com website to support pharmacists’ engagement around provider status.  On the site, you can find state-specific information and resources compiled by APhA, along with NASPA, that supports the case for recognition and the state and national level. 

Much of APhA’s success as an organization can be contributed to a focused strategic plan, forward thinking and diverse leadership, and a staff across the organization committed to our highest priority.  Through cross-divisional teamwork, each staff member puts a piece of the puzzle together and contributes to the organization’s mission and support-driven goals and objectives.  A major driver for their commitment is the mission of the organization – improving medication use and advancing patient care.

APhA is not only a unifying force within the profession, but within our own membership, connecting the various practice perspectives in guiding our activities towards achieving our vision for pharmacy practice.  We heard your desire for the ability to connect with colleagues across the country and developed a platform to do just that; we believe that will help us put the puzzle together even faster.  “APhA Engage” allows you to converse with colleagues, problem solve and collaborate on issues to enhance your ability to provide quality patient care and advance your career.  Through APhA Engage, Facebook, Twitter, and other social media tools, pharmacists are collaborating and speaking out regarding the value of our patient care services.

To continue and stimulate these connections, I want to tweet some of this excitement into the social media stratosphere.  I am definitely a newbie at this.  Are you with me?  Here we go! (take selfie and tweet)

Advancing as One: Unified Health Care Team

A vital component to completing our puzzle is to transform the role of the pharmacist via collaboration with other health care partners.  Keeping the patient as our focus, we have solutions to increase patient access to meaningful patient care services provided by pharmacists.  Components of highly productive teams, which many of us have, are: 1) talent; 2) processes; and 3) community.  Supporting this is collaboration, coordination and communication.  APhA and the APhA Foundation have facilitated stakeholder meetings that support our activities as members of the health care team and provide care models.

The APhA Foundation has demonstrated how integrating pharmacists in diabetes care can improve patients’ lives.  And many of you are succeeding at the personal level through innovative practices where pharmacists are integrated into health care teams.

Throughout 2014, Pharmacy Today profiled innovative practices of pharmacists integrated into health care teams.  We saw a pilot program in telehealth in which a pharmacist partners with home health services for homebound patients, and a collaboration between a family physician and a pharmacotherapy specialist to provide collaborative primary care, which you will hear about later this morning.  Pharmacists ARE making a difference.

We know that inter-professional practice will become the norm.  But we can’t practice interprofessionally on a large scale without connectivity.  Today’s student pharmacists are being trained within interdisciplinary teams, with each health care professional contributing their piece to the complex puzzle of patient care management.  The foundation of these teams is based on collaborative relationships, effective communication, and documentation of patient experiences and services provided for outcomes measurement. 

Through the work of the e-pharmacy HIT Collaborative, a group we helped found, the profession is now at the necessary tables to gain connectivity.  We have the tools, but need the opportunity to connect.  The biggest priority of the Collaborative has been the push for adoption, functionality, and implementation of electronic health records by pharmacists, so that they can exchange pertinent clinical information with other health care practitioners and maintain patient care records.  APhA continues to push for better integration of the pharmacist in the health care team.  In addition, we are engaged with the Pharmacy Quality Alliance (PQA) to advance the development of medication-related measures that can be used to measure the impact of pharmacists’ services.

Every time we need to make the case that new pharmacists’ services can scale, we point to the more than 260,000 pharmacists trained to administer immunizations.  APhA is viewed as a leader, facilitator, and collaborator on immunizations, driving an understanding of the immunization neighborhood and adoption of immunization standards.  We are not limited to flu vaccine!  We are working with other members of the immunization neighborhood to improve our nation’s low HPV and other vaccination rates. 

Through collaboration with the HHS National Vaccine Program Office we are exploring solutions, by engaging immunizing pharmacists, to improve our nation’s low HPV and other vaccination rates.  Pharmacists are recognized as important and accessible members of the immunization neighborhood, and, therefore, have a responsibility to educate the public about the importance of immunizations across the life span.  We have engaged in and led activities on numerous public health initiatives.

In February, pharmacist and CEO of the U.S. Public Health Service (USPHS) Commissioned Corps, and Director, Division of Commissioned Corps Personnel and Readiness, RADM Scott Giberson, who was the overall Commander of the Commissioned Corps Ebola Response in West Africa, introduced President Barack Obama at an event dedicated to America’s leadership in the fight against Ebola Virus Disease (EVD).  What a great honor for RADM Giberson and pharmacists!  Under Giberson’s direction, the USPHS Commissioned Corps opened a treatment center in West Africa.  Obama took the opportunity to thank pharmacist Giberson and his team, as well as many other workers on the front lines and behind the scenes responding to EVD.  APhA also wishes to thank Scott, USPHS Chief Pharmacist Pam Schweitzer, and the many pharmacists and health care team members who unselfishly serve the needs of their patients and communities every day.  This is an example of telling our story!

This past October, CDC’s Public Health Grand Rounds program focused on the important role that pharmacists can play in our health care system.  “How Pharmacists Can Improve Our Nation’s Health” highlighted pharmacists’ training, patient care services, and examples of how pharmacists are improving health outcomes.  This is the first Public Health Grand Rounds program to focus on a health care practitioner.

Advancing as One: Unified Patient Care Process

As care becomes more inter-professional, quality will be expected and measured.  Health care teams will scale more effectively with a clearly articulated and consistently utilized pharmacist patient care process. 

In 2014, APhA worked towards elevating pharmacy practice by reinforcing the value of pharmacists’ services, helping influence new health care delivery models, leading a multi-organizational stakeholder group in the creation of a new Pharmacists’ Patient Care process, and expanding our accreditation efforts.

While the Joint Commission of Pharmacy Practitioners’ (JCPP) consensus-developed pharmacists’ patient care process may seem to some as motherhood and apple pie, it creates predictable expectations for pharmacists’ patient care services.  This helps us better define our roles on the health care team in the eyes of our teammates, and paves the way for enhanced payment for the value we provide.  Medicine and nursing have a process of care, and thanks to the dedicated efforts of staff and members from multiple pharmacy organizations, pharmacy has one, too.  This may seem like a small step to those of you that provide patient care every day, but it’s another example of how doing the little things right make a difference.

We want our partners, our peers and our payers to know the value we provide.  As part of the provider status initiative, APhA collaborated with other pharmacy organizations to initiate an analysis of the evidence for pharmacists’ services in team-based care models through Avalere Health.  The independent report, Exploring Pharmacists’ Role in a Changing Healthcare Environment, was released in May 2014 and found positive evidence for pharmacists’ patient care services.  According to the report, “many of the pharmacist services… have been shown to improve therapeutic outcomes, adherence to medications, or reduced downstream healthcare costs.”  The report concluded that it is “critical that reimbursement policies” be “aligned to incent appropriate utilization of pharmacist services in order to deliver the highest value healthcare to patients.”

As the health care system moves to new models of care delivery, count on APhA to provide the tools for you to adapt and flourish with new knowledge, skills and services.  In 2014, more than 320,000 patients received health care services provided through APhA-ASP’s patient care projects; 42,000 pharmacists were trained through APhA’s training programs last year; and we now have more than 20,000 specialist pharmacists certified by the Board of Pharmacy Specialties (BPS), an autonomous division of APhA.  That says a great deal about pharmacists’ eagerness to grow! 

Conclusion

In Orlando, one year ago, I asked you to commit some of your time, talent and treasure to put one piece of our puzzle together, to make our profession just a little bit stronger.  I knew that we as an Association were driven by a purpose, a belief that we could make a difference in the lives of our patients. It has been a wonderful ride as your president; witnessing the swell of volunteers working together to make access to pharmacists’ services a reality in this changing world of health care.

We have made it this far by nurturing relationships and doing the little things right: keeping the patient’s needs before you; educating all your team members on the mission of our profession and our role on the team; and, engaging a fellow pharmacist in the political process.  We live in an Instagram world, and we must embrace change, but the relationships we nurture with our patients and our fellow providers are the foundation of pharmacy…Advancing as One.

You may not consider yourself a puzzle master, but by being here you’re finding where your puzzle piece fits.  Provider status is the challenge before us.  We are in this to win a championship: Our focus is increasing patient access to and coverage for pharmacists’ patient care services; providing tools and resources to be effective team members; telling our stories; and, making a difference, one patient at a time. 

Here, at the height of March Madness, it seems appropriate to quote another basketball legend, coach John Wooden, someone who knew something about winning. He said, "It's the little details that are vital.  Little things make big things happen."  Let’s not be afraid to foster new relationships, and “do the little things right” in making our big dream a reality.

Thank you for the opportunity to serve you and this wonderful pharmacy family.  I look forward to continuing the advance together.