Advancing Pharmacy Practice - MemberClicks

8/29/2013

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Advancing Pharmacy PracticeTrends, Challenges , Opportunities

Douglas Scheckelhoff, M.S., FASHPVice President, ASHP

ARKANSAS ASSOCIATION OF HEALTH‐SYSTEM PHARMACISTS

FALL SEMINAR

OCTOBER 3, 2013

• Define practice model and how the Pharmacy Practice Model Initiative (PPMI) can help advance practice models in hospitals

PHARMACYPRACTICE MODEL

New models of Care

• Identify opportunities and ways pharmacists should educate the public, patients, and payorsto enlist their support for availability of pharmacy care

IMPORTANT ROLE OFPHARMACY

TECHNICIANS

Training, Credentialing, Expanded Roles

• Explain how the availability of qualified pharmacy technicians will play a pivotal role in enabling the advancement of pharmacist practice

PHARMACISTPATIENT CARE

SERVICES

Acute and Ambulatory Care Settings

Overview and Objectives

• Identify opportunities and ways pharmacists should educate the public, patients, and payors to enlist their support for availability of pharmacy care

MEDICATION SAFETY

Med Use Process,Drug Shortages,

• Describe the changes in adoption of automation and technology and how it creates new opportunities for pharmacy

MEDICATION-RELATEDAUTOMATION AND

TECHNOLOGY

Need to do it right

• Explain how changes in society, healthcare and reform should shape where pharmacists practice and align with patient need

TRENDS INHEALTHCARE

Implications for Pharmacy

Overview and Objectives

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PHARMACY PRACTICE

MODEL

PRACTICE MODEL CHANGE - NEW METHODS OF CARE

What is a Practice Model?

• Defines important types and levels of patient care services

• Allows for:

o Application of best practices

o Standardization of care

o Judgment of pharmacist and individual patient needs

PRACTICE TRENDS CHALLENGES OPPORTUNITY


What is a Practice Model?

• Incorporates roles of pharmacists, technicians, and other support personnel into the provision of interprofessional care

• Encompasses patient care activities that span across all sites of care

• Optimizes technology and information systems to enhance care


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Imperatives for Practice Model Change

• Our Patients

o Medication use and its outcomes are far from optimal in the U.S.

o Admissions and readmissions to hospitals due to medication therapy are too high

o Provision of primary care and management of chronic disease is inadequate to meet the nation’s needs

o Wellness and prevention do not receive adequate attention



• Health System Spending

o National Health Expenditure,$2.7 trillion in 2011, $8,680 per person, and 17.9% of

GDP - projected to be 19.6% by 20211

o Estimated waste in the healthcare system = $765 BILLION annually2

o The Affordable Care Act (ACA) attempts to address these problems

o ACOs are designed to reward appropriate care utilization and ultimately capitate payment but need the full participation of pharmacists





• Pharmacists are the:

o Most accessible healthcare professionals

o Specifically and intensively educated and trained in drug therapy

• Maximizing pharmacists integration into health care teams will improve:

o Quality

o Safety

o Patient Satisfaction

o Financial Performance

PRACTICE MODEL CHANGE - NEW OPPORTUNITY


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PHILOSOPHY OF PRACTICE MODEL

10

Current Structure Future Direction

Dru

g

Dis

trib

uti

on

C

ente

red

Pat

ien

t-C

ente

red

In

teg

rate

d

Clin

ical

S

pec

ialis

t-C

ente

red

Co

mp

reh

ensi

ve*

Dru

g

Dis

trib

uti

on

C

ente

red

Pat

ien

t-C

ente

red

In

teg

rate

d

Clin

ical

S

pec

ialis

t-C

ente

red

Co

mp

reh

ensi

ve*

Characteristic % % % % % % % %

Staffed beds

<50 25.3 62.1 1.1 11.6 6.3 54.7 5.3 33.7

50-99 13.8 76.9 3.1 6.2 3.1 52.3 9.2 35.4

100-199 14.8 67.2 4.9 13.1 1.6 44.3 8.2 45.9

200-299 2.9 50.7 17.4 29.0 0 30.4 8.7 60.9

300-399 5.9 44.1 14.7 35.3 0 38.2 1.5 60.3

400-599 2.9 30.0 21.4 45.7 1.4 20.0 7.1 71.4

600 1.9 18.9 9.4 69.8 0 17.0 3.8 79.2

All hospitals - 2012All hospitals – 2011All hospitals – 2010

15.114.814.4

59.456.259.4

6.79.75.3

18.819.320.9

3.12.82.2

44.749.650.6

6.76.75.8

45.541.041.4

* - Comprehensive Model – Including pharmacists in distributive, generalist/integrated and specialist roles


PHARMACY PRACTICE MODEL INITIATIVE

12

Imperative for a better defined practice model identified by members.

Planning commences for summit: assumptions developed, ASHP members, thought leaders, and participants queried, briefing papers developed.

Demonstration and resident research grants issued

Consensus summit held resulting in 147 recommendations to better define characteristics of the optimal practice model for the future.

National dashboard developed to measure

progress

Briefing document webinar series conducted

Hospital Self‐Assessment (HSA) developed,

launched

Presentations at MCM, SM, Residency Conferences

PPMI Website with resources, links

launched

Summit Proceedings published in AJHP

Complexity tool developed

New focus on Ambulatory Care

Policy issues from summit addressed


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PHARMACY PRACTICE MODEL INITIATIVE

13

SummitRecommendations

Hospital Self-Assessment (HSA)

National Dashboard

National Dashboard Goals and Measures

147

105

26

5


GOAL 1

Pharmacist roles, practices, and activities will improve medication use and optimize medication related outcomes.

GOAL 2

Pharmacy technicians will prepare and distribute medications and perform other functions that do not require a pharmacist's professional judgment.

GOAL 3

Pharmacists and pharmacy technicians will have appropriate training and credentials for the activites performed within their scope of practice.

GOAL 4 GOAL 5

Pharmacists will demonstrateleadership in exercising their responsibility for medication use systems and will be accountable for medication‐related patient outcomes.

XX%

PPMI NATIONAL DASHBOARD

Pharmacy departments utilize availableautomation and technology to improve patient safety and improve efficiency.

2020

1000

8080

60.0%

4040

4040 4040 4040

6060 6060 60606060

10

3050

7070

9090

2020

1000

8080

18.6%

2020

1000

8080

25.9%

2020

1000

8080

52.7%

2020

1000

8080

46.7%

10 10 10 10

3030

50 50 50 50

70707070 7070 7070

90909090 9090 9090

606060606060 606040404040 4040 40403030

14


PHARMACIST PATIENT

CARE SERVICES

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CURRENT AND FUTURE TIME ALLOCATION

Pharmacy Technicians Current Future Change

Order processing / entry 4.5% 6.4%

Traditional drug preparation and distribution 78.6% 66.0%

Non‐traditional activities 8.2% 18.2%

Administrative 8.4% 9.0%

Other 0.3% 0.4%

Pharmacists Current Future Change

Order review and verification 46.0% 33.3%

Drug distribution 18.7% 12.9%

Clinical 21.7% 37.7%

Administrative management 7.7% 7.9%

Training (residents, students) 5.7% 8.0%

Other 0.2% 0.3%16


38%

21%

39%34%

50%

68% 69%

77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2012 <50 50-99 100-199 200-299 300-399 400-599 >=600

HOSPITALS WITH PHARMACISTS

ASSIGNED TO MOST PATIENTS(AT LEAST 8 HRS/DAY, 5 DAYS/WEEK)

17

% H

ospi

tals

# of Staffed BedsAll Hospitals


AREAS WITH PHARMACIST ASSIGNED > 8 HRS/DAY

Critical care

Oncology

Inpatient med

ical‐

surgical

Cardiology

Neo

natal

Specialty services:

anticoag

education

Ped

iatrics

Specialty services:

infectious disease

Emergen

cy

Dep

artmen

t

Obstetrics /

Gyn

ecology

Specialty services:

nutrition support

Operating Room /

Perioperative Areas

Specialty services: pain

and palliative care

Characteristic % % % % % % % % % % % % %

Staffed beds

<50 11.1 12.2 14.3 6.0 5.3 8.5 4.9 4.5 4.3 10.5 3.1 4.7 4.4

50‐99 26.2 21.6 30.2 14.0 6.2 15.1 11.1 8.0 8.1 14.0 7.8 8.2 4.2

100‐199 33.9 25.0 28.8 20.4 19.0 13.5 10.2 8.0 10.2 9.8 11.3 5.2 .0

200‐299 49.3 44.3 41.8 31.2 17.3 29.2 17.3 20.9 20.0 10.0 18.2 10.8 3.3

300‐399 73.5 65.1 65.7 60.6 39.7 36.9 40.0 33.3 36.9 26.7 23.1 30.8 6.3

400‐599 79.4 63.6 62.7 61.8 39.3 36.9 45.3 36.4 47.8 19.4 19.0 36.4 12.9

≥600 88.7 82.0 77.4 80.8 84.0 60.8 85.1 73.6 66.0 39.6 51.9 44.0 21.6

All hosp – 2012 36.9 34.8 31.7 27.2 20.9 19.4 16.7 15.4 14.9 13.8 12.4 11.1 4.6

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PHARMACIST CONSULTATIONS

% hospitals with pharmacists providing

consultations

% hospitals with ≥80% acceptance rate of recommendations

Consultation 2010 2001 2010 2001

Dosage adjustment 98.1 88.1 99.3 72.7

Drug information 98.1 91.9 97.3 66.0

Pharmacokinetics 90.6 76.9 98.5 85.3

Antibiotics 83.8 78.8 94.0 55.5

Anticoagulation 64.8 33.8 98.0 73.2

Nutrition support 52.4 46.7 99.3 76.9

Patient teaching 50.1 46.3 100.0 87.3

Pain management 41.7 38.0 98.9 65.9

Compliance 31.2 18.1 96.4 74.5


PHARMACISTS INVOLVEMENT

IN PATIENT CARE

59

82

82

0 20 40 60 80 100

Documentsrecommendations in

permanent med record

Authority to order serumconcentrations/other lab tests

Authority to write medicationorders

20

% hospitals

* Includes selection, initiation, monitoring and adjustment of medication therapy pursuant to diagnosis of a medical disease or condition

Modify/

Initiate by Protocol,

93%Authority

to Prescribe*

, 7%


PROPORTION OF PATIENTS DISCHARGED RECEIVING

TRANSITIONS OF CARE SERVICES BY PHARMACISTS

85

8

2

5

0 20 40 60 80 100

< 26%

26 - 50%

51 - 75%

> 75%

21% hospitals


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TRANSITIONS OF CARE PROCESSES USED BY

PHARMACISTS OR PHARMACY TECHNICIANS

5

10

11

12

12

17

22

24

27

0 20 40 60 80 100

Design a patient-specific medication-related actionplan

Handoff to community pharmacy at discharge

Prior authorization

Discharge prescription services

Communicating orders for home infusion services

Facilitate filling of prescriptions at an outpatientpharmacy

Discharge medication counseling by pharmacists

Participation in discharge planning

Manufacturer patient assistance programs

22% hospitals


PRIMARY RESPONSIBILITY FOR

MEDICATION REGIMEN INFORMATION*

Nurse79.4%

Multi-discipline

9.8%

Physician6%

Pharmacy Tech2.9%

Pharmacist2%

Collecting at Admission

Nurse81.4%

Multi-discipline

9.8%

Physician7.2%

Pharmacist1.6%

Disseminating at Discharge

*Neither pharmacy residents or pharmacy students were reported having primary responsibility

23


SYSTEMS WITH AN OUTPATIENT

DISPENSING PHARMACY

24

29%

12%

23%18%

45%

61%57%

70%

27%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<50 50-99 100-199 200-299 300-399 400-599 <=600 Total

2009

2012


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PHARMACISTS WORKING IN

AMBULATORY CLINICS

8.6% 8.0% 8.3%

28.6%

41.2%

56.5%

67.3%

18.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<50 50-99 100-199 200-299 300-399 400-599 >=600 Total

% o

f H

ospi

tals

# of Staffed Beds


HOSPITALS WITH PHARMACY STAFFED

AMBULATORY CLINICS

Clinics %

Anticoagulation 11.0Oncology 9.7General MTMS 6.2Diabetes 4.6Other 3.4Family medicine 3.1HIV/AIDS 3.1Lipid Control 3.1Pain Management 2.6Cardiac-hypertension 1.1


PHARMACY OPPORTUNITY

• Continue to expand pharmacist patient care services

• Transitions of care is a need of patients, and the organization

• Medication reconciliation

• Ambulatory clinics and other settings


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THE IMPORTANT ROLE OF

PHARMACY TECHNICIANS

DISTRIBUTION ACTIVITIES PERFORMED EXCLUSIVELY

BY PHARMACY TECHNICIANS

29

Preparation of first

doses (exc doses from

automated

devices)

Rep

lenishing unit

dose carts (if utilized

)

Restocking of floor

stock and/or au

tomtd

dispen

sing cabinets

Compounding sterile

preps (excluding

chemotherapy)

Compounding

chemotherapy

preparations

Controlled substance

system

managemen

t

Characteristic % % % % % %

Staffed beds

<50 19.1 71.4 70.8 22.5 20.7 28.1

50‐99 41.5 80.0 84.6 52.3 34.2 23.1

100‐199 50.8 78.4 90.2 68.9 40.0 31.1

200‐299 50.7 91.2 92.8 65.2 37.9 31.9

300‐399 67.6 91.7 95.6 79.4 70.8 48.5

400‐599 62.9 81.6 90.0 57.1 41.4 42.9

≥600 79.2 96.2 96.2 81.1 73.1 62.3

All hospitals – 2012 46.3 79.8 93.3 56.4 40.5 35.7

All hospitals – 2011 39.2 ‐‐ 77.6 47.6 ‐‐ 27.0


ACTIVITIES OF PHARMACY TECHNICIANS

3%6%10%11%11%

17%24%27%

40%61%66%

76%80%81%

93%94%95%97%

0% 20% 40% 60% 80% 100%

Dispensing with remote video supervision

Preparation of clinical monitoring information

Screening of medical records for MRPs

Medication assistance program mgmt

Medication reconciliation (obtaining list)

Tech‐check‐tech

Order entry (for pharmacist verification)

Technician supervising other technicians

IT system management

Controlled substance system mgmt

Compounding chemotherapy preps

Quality Assurance act/unit inspections

Billing

Compounding sterile preps

Packaging activities

Purchasing

Replenishing unit dose carts

Restocking floor stock and/or ADCs

% Hospitals with technicians performing activity

30


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PHARMACY TECHNICIAN

TRAINING AND CERTIFICATION

PTCB Certification

Completed an ASHP-

accredited Training Program

Characteristic % %Staffed beds

<50 69.1 28.150-99 71.5 13.8100-199 59.5 14.7200-299 58.2 8.2300-399 68.7 10.7400-599 77.2 17.1600 73.6 9.4

All hospitals – 2012 67.5 13.6All hospitals – 2011 65.8 11.1All hospitals – 2010 62.5 8.1All hospitals – 2008 58.4 13.5



• Promote training and certification of pharmacy technicians

• Be open to new and advanced roles of pharmacy technicians, especially those that directly impact patient care and allow shift of pharmacist focus to more patient care activities


MEDICATION SAFETY

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Summary of Findings:• Estimated 44,000 – 98,000 hospital

deaths annually in the U.S. due to medical erroro Equivalent to the downing of one

jumbo jet per day• Hospital deaths from medical error

exceed those caused by breast cancer or motor-vehicle collisions or AIDS.

• $29 billion annual cost to US healthcare system

• Over 7,000 deaths/year from medication errors

A BRIEF HISTORY: TO ERR IS HUMAN

Institute of Medicine

Committee on Quality

of Health Care in America. 2000


2010 REPORT: OFFICE OF THE INSPECTOR GENERAL

• One in seven patients experienced an adverse event

• 31% medication‐related

• 7 of 12 deaths caused by medication error (wrong drug, wrong dose, inadequate treatment of known side effects


BUT WE CONTINUE TO HAVE REPORTS OF

ADVERSE DRUG EVENTS…..


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PHARMACY OPPORTUNITY: BE PROACTIVE

Used PPMI Hospital Self-Assessment in Last 12 Months

Proactive and Ongoing Assessment of Risk in the in past 12 mo

<50 12.9% 46.7%

50-99 28.6% 58.5%

100-199 18.6% 59.0%

200-299 34.8% 72.5%

300-399 37.3% 79.1%

400-599 49.3% 87.0%

≥600 75.5% 79.2%

All hospitals – 2012 25.0% 60.1%

All hospitals – 2011 n.s 53.6%


PHARMACY OPPORTUNITY: LEADERSHIP IN IMPROVING MEDICATION SAFETY

• ASHP Positions and Policies• ASHP Policy Positions: Medication Misadventures• ASHP Statement: Reporting Medical Errors

ASHP Statement: Role of the Medication Safety Leader• ASHP Guidelines: Preventing Medication Errors with Antineoplastic

AgentsASHP Guidelines: Preventing Medication Errors in Hospitals

• National Quality Forum: Safe Practices for Better HealthcareSafe Practice 18: Pharmacist Leadership Structures And Systems:

Pharmacy leadership is the core of a successful medication safety program. Pharmacy leadership structures and systems ensure a multidisciplinary focus and a streamlined operational approach to achieve organization-wide safe medication use.


COMPOUNDING

New England Compounding Center:

• Large sterile compounding pharmacy shipping compounded products across the country

• Contaminated methylprednisolone recall –over 16,000 vials

• Meningitis cases =720

• Deaths = 61

Mold culture from meningitis victim


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COMPOUNDING

• Large scale compounders filled a need too Free pharmacy staff for patient care

o Outsource complex or time-consuming preparations

o Repackage or compound drugs that were in shortage

• Regulated as pharmacies, but engaging in manufacturing-like production procedures

• Scale of production not covered by current regulations


OUTSOURCING MEDICATION PREPARATION

Outsourced Activity 2011 2008 2005 2002

Outsource any preparation activities 70.9 41.8 31.0 21.0

Type of Preparation

PCA / epidural 73.3 64.0 40.2 16.7

Oxytocin 65.2 -- -- --

IV Admixtures / Piggybacks 38.3 37.3 31.4 15.7

Syringe-based anesthesia medications 24.1 -- -- --

Total parenteral nutrition solutions 23.6 32.8 39.8 52.4

Flushes 22.2 13.9 12.8 9.1

Cardioplegia 18.3 -- -- --

Unit-dose repackaging - drug only 16.0 13.4 11.6 12.1

Unit-dose repackaging - for bar coding 10.4 14.6 9.6 8.9

Other 16.9 20.6 25.8 28.0


EXTENT OF HOSPITAL OUTSOURCING: PERCENT OF TOTAL DOSES

% of doses outsourced

% of hospitals reporting

0-20% 83%

20-40% 14%

40-60% 2%

60-80% 1%

80-100% 0%


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HOSPITALS REPORTING THEY ARE

USP 797 COMPLIANT

65%

48%

70% 71%76% 77%

87% 88%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 <50 50-99 100-199

200-299

300-399

400-599

>=600

# of Staffed BedsAll Hospitals

% o

f H

osp

itals


PHARMACY OPPORTUNITY: ENSURING ONLY SAFE COMPOUNDED DRUGS

• Fill the gap in regulations for large scale compounders

• Preserve compounding as part of professional pharmacy practice

• Ensure safety of compounded drugs for patients and providers


MEDICATION-RELATED

AUTOMATION AND

TECHNOLOGY

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HOURS OF SERVICE

24/7/365

0%

6%

12%

19%19%

23%

29%31%

29%30%32%

34%36%

35%

39%37%

0%

10%

20%

30%

40%

50%

1961197519781982198519901992199420022005200620072008201020112012 46


24-HOUR REVIEW OF MEDICATION ORDERS

BY PHARMACISTS

30.1 32.3 33.8 35.9 34.538.7 37

3.12.5

5.04.9 8.8

11.1 15.9

5.37.5

6.5 6.29.8

11.712.9

1.9

3.63.1 2.2

3.6

1.92.3

59.654.0 51.6 50.9

43.436.7

32

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005 2006 2007 2008 2010 2011 2012

No review

On call

Affiliated Hospital

Company

24 hour service

47

% H

ospi

tals


ELECTRONIC HEALTH RECORD (EHR)

48

Complete EMR(no paper charts)

Partial EMR(some paper)

No EMR(all paper)

Characteristic % % %

Staffed beds

<50 22.1 54.7 23.2

50-99 15.4 61.5 23.1

100-199 8.2 73.8 18

200-299 15.9 66.7 17.4

300-399 30.9 63.2 5.9

400-599 24.3 68.6 7.1

600 35.8 60.4 3.8

All hospitals – 2012 18.6 62.9 18.5

All hospitals - 2011 8.0 58.7 33.3

All hospitals – 2010 7.7 50.9 41.4

All hospitals – 2009 8.8 47.1 44.1

All hospitals – 2007 3.8 37.2 59.0


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COMPUTERIZED PRESCRIBER ORDER ENTRY*

51% 52% 53% 54%

68%

61%

83%

4%9% 10% 11%

15%19%

34%

54%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005 2006 2007 2008 2009 2010 2011 2012 <50 50-99 100-199

200-299

300-399

400-599

>=600

49# of Staffed BedsYear

% H

ospi

tals

* With clinical decision support


BAR CODE MEDICATION ADMINISTRATION

60%

66%

72%

65%

72%

67%

60%

9%13%

20%25% 27%

35%

50%

66%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005 2006 2007 2008 2009 2010 2011 2012 <50 50-99 100-199

200-299

300-399

400-599

>=600


% H

ospi

tals


SMART INFUSION PUMPS

63%

75%

90%

78%

91%87%

96%

32%37%

41%

59%56%

68%

77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005 2006 2007 2008 2009 2011 2012 <50 50-99 100-199

200-299

300-399

400-599

>=600


% H

ospi

tals


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e-MAR BECOMES STANDARD

54%64%

55%47%

24%

21% 37%67%

46%36%

24%17%

8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1999 2002 2005 2008 2011

Handwritten

e-MAR*

ComputerGenerated

* e‐MAR not surveyed before 2005

% of Hospitals


PHARMACY OPPORTUNITIES

• Lead adoption of automation and technology that will improve efficiency, safety

• Bring pharmacy expertise to technologies that involve medications to ensure appropriate, safe use


TRENDS IN HEALTH CARE

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CHANGES IN SOCIETY

• Aging population

• Increasing diversity

• Disparities in healthcare

• Better informed consumers


CHANGES IN HEALTHCARE

• Healthcare workforce challenges

• Focus on quality, pay for performance

• Hospital finances remain fragile

• Greater scrutiny, transparency

• Shift toward patient-centered care

• Expanding use of technology


Understanding ACOs• Restructuring of Health Care Delivery

o Networks/groups of health care providers (physicians, hospitals, clinics, health-systems, community pharmacies, etc.) jointly responsible for patients

• Settings of Care Necessaryo Ambulatory Careo In-Patient Careo Long-term Care

THE ACCOUNTABLE CARE ORGANIZATIONConnecting All Aspects of the Medication-Use Continuum

• “Triple Aim”o Reduce costso Increase qualityo Improve health in community at

large


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ASHP ACO Task Force• 13 individuals with administrative and clinical

experience with ACOs in various health care settings

o Purpose: To explore how pharmacy can improve medication use in the ACO model

o Goals:

o Improve medication outcomes in and across all sites of care

o Reduce admissions and readmissions

o Improve clinical processes of care

o Enhance patient experience

o Reduce cost of care



ASHP ACO Task Forceo Recommendations:

o Pharmacists need to more fully participate in ACO care design and provision

o Identify and focus on high-risk patients and communicate across the health care continuum

o Measure quality and financial impact of pharmacist on the ACO



ASHP ACO Task Forceo Recommendations:

o Redesign pharmacy services – “System of Care” Model

o Deploy appropriate pharmacy resources across multiple settings

o Allocate budgets based on:

o Incorporate automation and technology to improve efficiency, accuracy, and convenience of patient care services

THE ACCOUNTABLE CARE ORGANIZATION

o Diseaseo Interventions Requiredo Treatment

Connecting All Aspects of the Medication-Use Continuum


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• Understand changes occurring in health care delivery

• Be strategic in planning and advancing pharmacy services

• Align pharmacy services with patient needs and changes:

Transitions of care Ambulatory care

Cost management Care coordination

CMS triple aim goals Others


Questions & Answers

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