Community Pharmacy Practice Roundtable Report, 2023

PHARMACY DEANS RESEARCH GROUP

COMMUNITY PHARMACY PRACTICE ROUNDTABLE

Gaylord Rockies Resort, Aurora, Colorado

July 21, 2023

HOSTED BY SUPPORTED IN PART BY

CONTENTS

2 Executive Summary

3 Opportunities

5 Challenges

7 Initiatives

10 Next Steps

11 Participants

EXECUTIVE SUMMARY

On July 21, 2023, the CEO Deans of the Pharmacy Deans Research Group (PDRG; representing the top 25 R1 pharmacy schools), their communitybased practice leads, and select AcademiaCommunity Transformation (ACT) Pharmacy Collaborative Champions came together with Walgreens for a Community Pharmacy Practice Roundtable to progress community-based pharmacy practice through collaboration, innovation, and education. This roundtable identified multiple opportunities for creating a unified and positive image of the pharmacy profession, increasing patient-centric services, and improving payment models for pharmacy practice. Key strategic initiatives were identified for continued collaboration to elevate community pharmacy practice and improve patient care

The roundtable goals were to:

Appreciate the opportunities for patient care in community-based pharmacy settings. Address challenges or barriers to the implementation of patient care. Identify key initiatives to transform community-based pharmacy practice to improve patient outcomes.

Opportunities to capitalize included:

Marketing & Communications - marketing to young audiences and the public, and using a consistent vernacular around communitybased practice.

Education & Advocacy - educating students and faculty about community-based practice, using our schools as neutral conveners, educating legislators, and working together to shape policy change.

Clinical Services - leveraging practice-based research, partnering with corporate pharmacies to improve community-based pharmacy workflow, utilizing our students' skills to scale patient care services and generate impact data, and using technology to enhance clinical services.

Challenges or barriers to address included:

Curricular - ensuring students have a curriculum/co-curriculum focused on the business of healthcare, and conducting experiential education assessments to improve community-based practice sites. Perception - performing public marketing with one voice, improving professional perceptions about community-based practice, and educating clinician partners about value-based care partnerships with community-based practice.

Utilization - fully utilizing pharmacists as the medication experts to ensure access, optimize medication use, and promote health and well-being Variations in the scope of practice limit pharmacist engagement with patients across states, and pharmacists are routinely reimbursed based on medication product rather than team-based services provided.

Initiatives – Roundtables identified and prioritized 12 initiatives. The following next steps were identified:

Partner together to develop public service announcements on pharmacy career potential and impact.

PDRG Deans develop shared messaging for community-based practice.

PDRG schools and Walgreens engage in the Align Summit.

Walgreens to partner with PDRG schools and AACP/ACT on using Flip the Pharmacy framework to implement patient services in their stores at scale.

OPPORTUNITIES

Stefanie Ferreri articulated key data for community pharmacy, noting that 63% of graduating PharmD students and 42% of PharmD alums identified community pharmacy as their primary place of employment (2022 AACP survey). She noted endless opportunities for pharmacist-led patient engagement because patients visit their community pharmacy ~10x more frequently than their primary care physician Using the pandemic as an example, community-based pharmacists demonstrated significant impact in improving patient care at a lower cost (Figure 1)

Speakers provided three perspectives on the top opportunities for patient care in community-based pharmacy settings:

JohnColaizzi(WalgreensPerspective) identified opportunities for technology-enabled models to support the future of community-based pharmacy practice, beginning with efficiencies through micro-fulfillment and centralized services. He noted that Walgreens wishes to reinvent the patient experience by adding digital solutions, expanding clinical services, and changing store format (to place the pharmacy in the front) to increase patient engagement.

MirandaSteinkopf(AACPPerspective) described the goals of the ACT Pharmacy Collaborative as uniting schools of pharmacy and pharmacist leaders to transform communitybased practice, mobilizing stakeholders to facilitate the implementation of community-based care, and amplifying the implementation of sustainable care delivery. She described three ACT Signature Programs as opportunities for the coming year: PharmD Student Scholars, a Faculty Practice Transformation Badge, and a Center of Excellence Program for Pharmacy Schools.

KellyGoode(AcademiaPerspective) described 181 PGY1 community-based residency programs nationally. She identified opportunities for community-based pharmacist services, including wellness and prevention, laboratory testing and screening, patient education, and medication optimization. She noted that these activities can go beyond the walls of a community pharmacy and include patient home visits or being embedded/semi-embedded in medical offices or senior care facilities. To improve the health and economics of the communities they serve, community-based pharmacists have the opportunity to address the quintuple aims: improved patient experience, better outcomes, lower costs, clinician wellbeing, and health equity.

IN THE PANDEMIC, COMMUNITY-BASED PHARMACISTS...

administered 45% of all US vaccines

tested >42 million patient specimens

provided >100,000 monoclonal antibody treatments averted >8 million hospitalizations and >1 million deaths saved health care $450 billion

Figure 1

John Colaizzi, Vice President of Pharmacy Services and Delivery at Walgreens, spoke about future opportunities made possible by technology-enabled models.

BREAKOUT DISCUSSION

Howcanacademiaandcommunity-basedpharmaciespartnertohighlightpractice transformationandenhanceeducation?

Four themes emerged with key opportunities for partnership:

UseConsistentVernacular: Words matter, and a consistent collective set of positive terms should be adopted within the academy for community-based pharmacy practice. For example, “clinical pharmacy” is practiced in all settings involving patients, and “community-based practice” is preferred to “retail pharmacy”.

MarketToYoungAudiencesandthePublic: Better leverage our students and their social media presence to reach youth. Academia can partner with Walgreens to highlight the joy of the profession and the impact of pharmacists on patients. Produce a national public service campaign about the positive influence of community-based pharmacists (consider JCPP partnership).

EducateOurStudentsandFaculty: Provide students with intentional early exposure to robust community-based practice models. Use students to “Flip the Pharmacy” and extend patient care services using clinical skills. Expose faculty to impactful models of community-based practice. Use alumni and preceptors to develop real-world cases from community-based practice for pharmacotherapy courses Lean in on the impact of pharmacy in rural/underserved communities

PositionSchoolsasaNeutralConvener,LegislatorEducator,andResearchResource: Academia is well-positioned to serve as an impartial convener of community-based pharmacies, payors, providers, and other partners to develop new models of care to fill healthcare gaps. Additionally, academia can help educate legislators, host legislative visits to progressive community pharmacies, and extend research/data analytics (and grantsmanship) needs of community pharmacies.

Howcanacademiaandcommunity-basedpharmaciespartnertohighlightpractice transformationandenhanceeducation?

Four themes emerged to scale medication optimization:

OptimizeWorkflow: Community-based pharmacy must address workload concerns for solutions to be scalable. With appointment-based models and central fill, allow patient-centered services to fill vacated dispensing time. Partner with academia to utilize Flip the Pharmacy champions to transform daily operations, pursue patient-centered projects, and collect data on clinical, economic, and humanistic impact. Standardize a common set of patient-centered services across all pharmacies.

LeverageLearners: Students and residents can assist with workflow changes, extend communitybased patient care services, develop standardized documentation methods, and collect/analyze impact data. Graduate students and postdoctoral fellows can assist with population or implementation science projects, data collection, analytics, and economic modeling

ImplementTechnology: Implement telehealth services to remove geographic barriers to medication counseling or “ask the pharmacist” time. Partner with health systems/clinics to allow EHR access. Schools can use their technology platforms to highlight/catalogue clinical services provided in community-based pharmacies.

ShapePolicyChange: Combine outcomes with impact data to present to payors/legislators on pharmacy policy changes that would improve the health and economics of their communities. Meet with medical societies to discuss collaborative efforts to improve outcomes, well-being, and opportunities to fill healthcare gaps. Develop forums to share best practices across state lines, convening Boards of Pharmacy.

CHALLENGES

In her introduction to challenges, Stefanie Ferreri emphasized that community-based pharmacists can address the following annual healthcare spending: $100B in excess hospitalizations due to medication nonadherence, and $528B due to misuse, underuse, or overuse of medications She presented data on how optimal medication use can provide a 3:1 to 10:1 return on investment for chronic conditions such as diabetes, hypertension, hypercholesterolemia, and congestive heart failure. She noted that community-based pharmacists need to be integrated into team-based care, but identified barriers such as workload challenges, reimbursement of medication product rather than compensation for services, and variation in scope of practice across states.

Speakers provided three perspectives on challenges to practice transformational change:

LisaTomic(WalgreensPerspective) focused on four areas of concern and activities to address them Addressing pharmacistshortages requires increasing compensation as well as more engagement with high school students, PharmD students, pharmacy school deans, and pharmacy associations. Countering declining pharmacyreimbursementrates necessitates PBM reform, state mandates of payment of services, and expanded clinical services.

Overcoming legislativeandregulatorybarriers requires supporting scope-of-practice expansion for pharmacists and technicians, implementing central fill, and reducing pharmacist administrative burden. Pandemic-related burnout has prompted a need for implementing central fill, expanding remote work opportunities, and eliminating the collection of work metrics.

RandyMcDonough(ACTPerspective) provided additional insight on challenges including vertical alignment of payors/PBMs, encroaching mail order companies, dramatic reduction in payments for products (due to DIR fees, clawbacks, lack of payment models for community-

based patient care services, and a general focus on drug costs rather than inappropriate drug use. He articulated using Flip the Pharmacy to create capacity for patient care and discussed new models such as cash-based practices, direct contracting, concierge practice, embedding primary care providers into community pharmacies, and developing value-based arrangements with payors. He also emphasized current opportunities available to create innovative, nontraditional pharmacy practice models (Figure 2).

Jordan Ballou (Academia Perspective) discussed faculty vernacular and how certain words (e.g., retail, store) can enforce negative perceptions about community-based pharmacy practice. She also noted partnership challenges, with faculty not knowing how to engage community-based pharmacists and communitybased pharmacists unable to identify opportunities to collaborate with faculty. She reviewed the ACT curricular framework and proposed community-based pharmacy practice skills be integrated into the PharmD curriculum to support practice transformation, including developing care plans for diverse populations, identifying evidence-based pharmacy services, and learning how to implement/assess them.

Figure 2: Diverse career opportunities available for pharmacist innovators (AJPE 2022;86(8) Article 8773)

BREAKOUT DISCUSSION

Howcanschoolsbetterpreparestudentsfornewbusiness/paymentopportunitiesfor community-basedpharmacists?

Two themes emerged:

Curriculum/Co-curriculumFocusonTheBusinessofHealthcare: Ensure students understand the current healthcare marketplace and payment landscape (DIR fees, PBM, PDC, etc.). Provide realworld cases/experiences from community-based practice using employers, preceptors, and alumni. Embed current payment models into therapeutic cases. Ensure students understand how to integrate technology to predict and manage workflow. Engage students in developing new services as part of a course, the co-curriculum, a competition (NCPA business plan, AMCP competition, “Shark Tank” pitch events), a research project, or a dual-degree (MBA, MPH) project. Provide opportunities within the curriculum to discuss disruptive content including new ways of practicing. Identify opportunities for ACPE to seek advice from those with expertise in the healthcare marketplace.

ExperientialEducationAssessment: Prioritize experiential sites that have implemented and are being compensated for community-based patient care services to ensure students experience how pharmacists generate revenue and healthcare cost-savings in these outpatient settings

Howcantheprofessionchangethecurrentperceptionandmessagingofcommunity-based pharmacypractice?

Four themes emerged to scale medication optimization:

ImproveCommunity-BasedPracticeSites: Provide feedback to partners on student perception of the workplace, such as pharmacist compensation, workload, well-being, ability to provide clinical services, etc. Prioritize those experiential sites that rank highest with the student experience.

PublicMarketingwithOneVoice: Build on pandemic success to improve public perception and amplify one message from our institutions. Engage with ACT and JCPP to assist with a national campaign. Host a National Open House Day at community pharmacies nationwide and engage students to assist at those sites. Develop a Reddit army to change the conversation on pharmacy subreddit to highlight the good.

ImproveInternalPerception: Deans speak with one voice around the importance of communitybased pharmacy. Educate faculty on exciting opportunities in community-based practice. Walgreens can help by providing examples to be shared in town halls, seminars, and site visits for faculty. Ensure students have access to the most innovative models in community-based settings.

EducateClinicianPartners: Maximize inter-professional education opportunities to solidify community-based pharmacists as part of the healthcare team. Identify collaborative practice models that are effective and disseminate to clinician audiences other than pharmacy (NP, PA, MD, DO, DDS) Identify clinician champions and practices that can be exemplars to payors, legislators, and other key stakeholders. Facilitate clinician/pharmacist connections in the community to help develop these collaborative practices

INITIATIVES

The roundtable culminated in a discussion of key initiatives to foster transformation of communitybased practice to improve patient outcomes. Stefanie Ferreri provided examples in four areas:

Professional advocacy to shape health policy

Public health education

Research and evaluation of practice models

Workforce transformation

MelissaMcGivney(ACTperspective) described key partnership elements, leading with a willingness to understand culture/structure and think creatively. She noted the need for strong administrative leadership to set the vision, sustain the partnership, and troubleshoot issues. Partnerships are rooted in trust and transparent communication. She concluded by sharing examples of how to engage students (Figure 3), implement pharmacy practice models, evaluate models through scholarship, and provide legislative advocacy.

BREAKOUT DISCUSSION

Howcanschoolsbetterpreparestudentsfor newbusiness/paymentopportunitiesfor community-basedpharmacists?

Key theme identified:

DataSharing: Walgreens can partner with schools to evaluate the impact of central fill on community-based practice activities and patient outcomes for local, regional, and national impact. Schools can partner with community-based pharmacies to evaluate the implementation/uptake of practice act changes and patient outcomes and to help standardize the documentation of interventions and outcomes of services. Better collaboration across states to replicate payor pitches by using one-page impact statements Use Artificial Intelligence to create a shared resource that summarizes services and impact. Enhance data-science skills among student pharmacists so that they can assist with these assessments.

Figure 3: Impact of engaging 235 PharmD students in the 2019 National Day of Service led by the ACT Pharmacy Collaborative Day of Service led by the ACT Pharmacy Collaborative

INITIATIVES

Tables were asked to identify a top initiative that would help transform community-based practice and vote on the results.

I'm Just a Pill (combined with “Pharmacy Megaphone”)

Walgreens to develop School House Rock-style PSA campaign that describes the drug development process and cites the role of pharmacists, scientists, and clinicians in the optimization of medication therapy for patients. This would allow a focus on younger audiences. Based on in-meeting feedback, these votes were combined with “Pharmacy Megaphone” initiative, which suggested working with JCPP for impactful national messaging.

Votes: 33

Deans' Stake in the Ground

PDRG comes together to agree on language for community practice transformation and then BOLDLY announces the stance to faculty and students and alumni all at the same time.

Votes: 22

Community of Learning

Create and facilitate a community of learning among conveners of regional efforts focused on pharmacist provider-health plan partnership formation (see Align Summit Sept 2023)

Votes: 15 Bus

Tour

Similar to when schools used to take annual trips to Eli Lilly, schools can tour Walgreens and/or other community-based pharmacy practice sites that highlight everything that community practice has to offer.

Votes: 10

PharmRxs only Match Making

A system for intentional matching/pairing of Academic Institutions and Community-Based Practices to create partnerships for research and making change specifically around implementation science for amplification

Votes: 9

Increase Representation

Increase the number of pharmacy faculty in community-based pharmacies. Explore opportunities for alternative funding models.

Votes: 8

INITIATIVES

Convert and Compile

Convert and compile existing research proving the value of pharmacist-led patient care services to a one-pager as a tool to assist with advocacy for payment reform

Votes: 5

Pharmacy Innovation To Change Healthcare (PITCH)

Create a competition for groups of student pharmacists nationwide to pitch innovative services to recognized leaders in community-based pharmacy practice to disrupt and innovate in healthcare.

Votes: 5

Student Leadership Institute in Community-Based Pharmacy

Host a leadership institute to provide student pharmacists with skills and mentorship in practice transformation. Different universities host the institute every year.

Votes: 4

From Community Partners to Students

PDRG schools identify their network of community partners and faculty to work together in setting the agenda for using pharmacy students as change agents.

Votes: 3

Resource Bank

Create resources for pharmacy schools to use to ensure

students

understand innovative opportunities in community-based pharmacy practice in a format that can be transferable to CE for alumni

Votes: 2

Disseminate Best Practices/Good Stories

Identify 3-5 community-based practice sites that have a partnership with a physician champion and develop feasible, outcome-based practices that could be disseminated/implemented and tracked Use existing stories from partners (e g , Walgreens) to promote positive impact messaging

Votes: 1

NEXT STEPS

Each school is encouraged to utilize any ideas that could be helpful. Next steps identified through discussions during the day include the following:

PDRG deans develop “stake in the ground” messaging for community-based practice.

PDRG schools, AACP/ACT, and Walgreens partner to develop public service announcements for youth outreach on the potential of pharmacy careers

PDRG schools and Walgreens engage together in a community of learning through the Align Summit

Walgreens partners with PDRG schools and AACP/ACT to utilize Flip the Pharmacy framework for implementing patient care services in their stores to transform pharmacy practice.

KEYCONTACTS

ACTPharmacyCollaborative Melissa McGivney mmcgivney@pitt.edu

FlipthePharmacy

Randy McDonough rmcdonough@towncrest.com

CPESN

Troy Trygstad info@cpesn.com

CommunityPharmacyFoundation Kelly Brock kbrock@communitypharmacyfoundation.org

UNCEshelmanSchoolofPharmacy Stefanie Ferreri stefanie ferreri@unc.edu

Walgreens

John Colaizzi john.colaizzi@walgreens.com

PARTICIPANTS

SPEAKERS

Jordan M. Ballou, PharmD, BCACP, University of South Carolina College of Pharmacy

John Colaizzi, Jr, PharmD, RPh, Vice President of Pharmacy Services and Delivery, Walgreens

Stefanie Ferreri, PharmD, BCACP, FAPhA, UNC Eshelman School of Pharmacy

Jean-Venable “Kelly” R. Goode, PharmD, BCPS, FAPhA, FCCP, VCU School of Pharmacy

Angela Kashuba, BScPhm, PharmD, DABCP, FCP, UNC Eshelman School of Pharmacy

Randal P. McDonough, PharmD, MS, BCGP, CPS, FAPhA, Loma Linda University

Melissa Somma McGivney, PharmD, FCCP, FAPhA, University of Pittsburgh School of Pharmacy

Miranda Steinkopf, PharmD, BCACP, AACP Transformation Center

Lisa Tomic, PharmD, RPh, Vice President of Pharmacy Operations, Walgreens

TABLE FACILITATORS

Stacey Curtis, PharmD, CPh, University of Florida College of Pharmacy

Ashley Hannings, PharmD, BCACP, University of Georgia College of Pharmacy

Katelyn Nicole “Katie” Hettinger, PharmD, MS, Purdue University College of Pharmacy

Clark Kebodeaux, PharmD, BCACP, University of Kentucky College of Pharmacy

Tamara Ayanna McCants, PharmD, Howard University College of Pharmacy

Wesley Nuffer, PharmD, BCPS, CDCES, CU Skaggs School of Pharmacy and Pharmaceutical Sciences

Shanna O’Connor, PharmD, Dakota State University College of Pharmacy & Allied Health Professionals

Laura A. Rhodes, PharmD, BCACP, UNC Eshelman School of Pharmacy

WALGREENS

Nichole Cover, RPh, Director of Pharmacy Affairs

Amer Hakam, PharmD, PhD, Regional Healthcare Director

Kristi Mihok, RPh, Healthcare Supervisor

Scott Tomerlin, PharmD, CPh, Pharmacy Affairs Manager

Diego Villalba, PharmD, AAHIVP, Healthcare Specialty Supervisor

Lorri Walmsley, RPh, FAzPA, Director of Pharmacy Affairs

SPECIAL GUEST

Kelly Brock, PharmD, RPh, Executive Director of the Community Pharmacy Foundation

PHARMACY DEANS RESEARCH GROUPS (PDRG)

Ralph J. Altiere, PhD, CU Skaggs School of Pharmacy and Pharmaceutical Sciences

Eric L. Barker, PhD, Purdue University College of Pharmacy

Brookie Best, PharmD, MAS, UCSD Skaggs School of Pharmacy

Vicki Ellingrod, PharmD, FCCP, FACNP, University of Michigan College of Pharmacy

Reginald F. Frye, PharmD, PhD, FCCP, University of Tennessee HSC College of Pharmacy

Kelechi "KC" Ogbonna, PharmD, MSHA, Virginia Commonwealth University College of Pharmacy

Peggy Odegard, PharmD, CDE, University of Washington School of Pharmacy

Vassilios Papadopoulos, PharmD, PhD, USC Mann School of Pharmacy & Pharmaceutical Sciences

Randall T. Peterson, PhD, University of Utah College of Pharmacy

Samuel M. Poloyac, PharmD, PhD, University of Texas at Austin College of Pharmacy

Glen T. Schumock, PharmD, PhD, University of Illinois Chicago College of Pharmacy

Rick G. Schnellmann, PhD, University of Arizona R. Ken Coit College of Pharmacy

Amy Lynn Seybert, PharmD, University of Pittsburgh School of Pharmacy

Kelly Smith, PharmD, FASHP, FCCP, University of Georgia College of Pharmacy

Steven Swanson, PhD, University of Wisconsin School of Pharmacy

Lynda S. Welage, PharmD, FCCP, University of Minnesota College of Pharmacy

PDRG PRACTICE LEADS

Julie Akers, PharmD, Washington State University College of Pharmacy and Pharmaceutical Science

Ashley Castleberry, PharmD, MEd, University of Texas at Austin College of Pharmacy

Kim Coley, PharmD, FCCP, University of Pittsburgh School of Pharmacy

Robin Corelli, PharmD, UCSF Skaggs School of Pharmacy and Pharmaceutical Sciences

Christopher Daly, PharmD, MBA, BCACP, UB SUNY School of Pharmacy & Pharmaceutical Sciences

Richard Dang, PharmD, APh, BCACP, FCPhA, USC Mann School of Pharmacy & Pharmaceutical Sciences

Kelsey Frederick, PharmD, University of Tennessee HSC College of Pharmacy

Diane Ginsburg, RPh, MS, PhD, FASHP, University of Texas at Austin College of Pharmacy

Elizabeth Hall-Lipsy, JD, MPH, University of Arizona R. Ken Coit College of Pharmacy

Marlowe Djuric Kachlic, PharmD, BCACP, University of Illinois Chicago College of Pharmacy

Cherokee Layson-Wolf, PharmD, BCACP, FAPhA, University of Maryland College of Pharmacy

Macary Marciniak, PharmD, UNC Eshelman School of Pharmacy

Beth Martin, PhD, MS, RPh, FAPhA, University of Wisconsin School of Pharmacy

Nikki Olenik, PharmD, Purdue University College of Pharmacy

Amy Thompson, PharmD, BCACP, University of Michigan College of Pharmacy

Frank Romanelli, PharmD, MPH, FAPhA, BCPS, AAHIVP, University of Kentucky College of Pharmacy

Kelsey Schwander, PharmD, CU Skaggs School of Pharmacy and Pharmaceutical Sciences

Todd Sorensen, PharmD, University of Minnesota College of Pharmacy

Chardae Whitner, PharmD, University of Florida College of Pharmacy

Henry Young, PhD, FAPhA, University of Georgia College of Pharmacy