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 3 5 7 10 11

Executive Summary Opportunities Challenges Initiatives Next Steps 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: 1. Partner together to develop public service announcements on pharmacy career potential and impact.

2. PDRG Deans develop shared messaging for community-based practice.

3. PDRG schools and Walgreens engage in the Align Summit.

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

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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: John Colaizzi (Walgreens Perspective) 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.

Miranda Steinkopf (AACP Perspective) 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.

Kelly Goode (Academia Perspective) 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.

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OPPORTUNITIES

BREAKOUT DISCUSSION How can academia and community-based pharmacies partner to highlight practice transformation and enhance education?

Four themes emerged with key opportunities for partnership: Use Consistent Vernacular: 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”.

Market To Young Audiences and the Public: 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).

Educate Our Students and Faculty: 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.

Position Schools as a Neutral Convener, Legislator Educator, and Research Resource: 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.

How can academia and community-based pharmacies partner to highlight practice transformation and enhance education?

Four themes emerged to scale medication optimization: Optimize Workflow: 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.

Leverage Learners: 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.

Implement Technology: 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.

Shape Policy Change: 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.

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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.

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).

Speakers provided three perspectives on challenges to practice transformational change: Lisa Tomic (Walgreens Perspective) focused on four areas of concern and activities to address them. Addressing pharmacist shortages requires increasing compensation as well as more engagement with high school students, PharmD students, pharmacy school deans, and pharmacy associations. Countering declining pharmacy reimbursement rates necessitates PBM reform, state mandates of payment of services, and expanded clinical services.

Overcoming legislative and regulatory barriers 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.

Randy McDonough (ACT Perspective) 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-

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

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.

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CHALLENGES

BREAKOUT DISCUSSION How can schools better prepare students for new business/payment opportunities for community-based pharmacists?

Two themes emerged: Curriculum/Co-curriculum Focus on The Business of Healthcare: 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.

Experiential Education Assessment: 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.

How can the profession change the current perception and messaging of community-based pharmacy practice?

Four themes emerged to scale medication optimization: Improve Community-Based Practice Sites: 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.

Public Marketing with One Voice: 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.

Improve Internal Perception: 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.

Educate Clinician Partners: 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.

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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: 1. Professional advocacy to shape health policy 2. Public health education 3. Research and evaluation of practice models 4. Workforce transformation Melissa McGivney (ACT perspective) 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 How can schools better prepare students for new business/payment opportunities for community-based pharmacists?

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.

Key theme identified: Data Sharing: 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.

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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 Page 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

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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.

KEY CONTACTS

ACT Pharmacy Collaborative Melissa McGivney mmcgivney@pitt.edu Flip the Pharmacy Randy McDonough rmcdonough@towncrest.com CPESN Troy Trygstad info@cpesn.com Community Pharmacy Foundation Kelly Brock kbrock@communitypharmacyfoundation.org UNC Eshelman School of Pharmacy Stefanie Ferreri stefanie_ferreri@unc.edu Walgreens John Colaizzi john.colaizzi@walgreens.com

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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

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PARTICIPANTS

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

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