University of Florida College of Pharmacy/UF Community Health and Family Medicine Clinic
Community Health and Family Medicine Clinic (CHFM Old Town) is located in Old Town, FL. This University of Florida rural based clinic is 40 miles west of the UF campus and services the population in surrounding counties: Dixie, Levy, Gilchrist, Taylor, and Alachua. Currently 0.4 total pharmacist FTEs are dedicated to staffing in this clinic by a UF College of Pharmacy (UF COP) faculty, which also serves as an educational site for two ASHP accredited PGY2 Ambulatory residents and numerous APPE students from UF COP. The clinic hosts approximately 12,000 visit/year with five family medicine and internal medicine attending level physicians who split time between research/teaching/practice. Pharmacy services are provided in a High-Risk Collaborative Care (HRCC) model, which managed just shy of 1,300 patient encounters this past fiscal year. Most of the HRCC patients are managed with face-to-face encounters scheduled on a separate pharmacy patient panel, but recent efforts have been placed to engage in chronic care management (CCM) telephone encounters for targeted populations. Most typical conditions focused on in the collaborative appointments include diabetes, hypertension, ASCVD risk prevention, tobacco cessation, anticoagulation, medication assistance and education, and new emerging areas of COPD and osteoporosis.
Why was the pharmacy service developed? (Describe any compelling data collected prior to implementation)
This clinic was established approximately 9 years ago and has evolved from pharmacy service focusing on the chronic medical conditions noted above and using only incidence-to billing to a more robust collaboration with focus to increase patient access and relative value unit capture. Our collaborative focus has been placed on contributing to increasing patient access for chronic disease management, expanding the vision of medical conditions addressed, optimizing medication utilization with contemporary literature, contributing to the improvement of tracked quality metrics (A1c, vaccination rates, BP levels, among others), and creating a sustainable model both financially and with scholarship collaborations.
What training, certification, credentialing, and practice agreement is utilized by the practice setting pharmacist(s)?
Standard collaborative practice agreement and board certification have been established as a baseline expectation. The site is also pursuing becoming an approved tobacco cessation facilitator through the Area Health Education Centers (AHEC) Program.
What outcomes are being measured to evaluate the model's success? (Clinical metrics, revenue, cost-savings, patient satisfaction, etc.)
The clinic tracks CMS MIPS metrics with the pharmacy service contributions adding to the improved and maintained quality metrics. Outside of the clinic tracking, the pharmacy service follows comparative data for A1c improvement with consideration to “touches” for pharmacy service patients. This past year a statistical decrease in A1c for those patients that were managed with the pharmacy team was noted. Other tracking includes appropriateness of medications in select population such as heart failure, opportunities for chronic management expansion such as osteoporosis and COPD, and time in therapeutic range are among the many tracked activities. A new educational effort has also been developed and implemented to increase certified medical assistants medication knowledge. The first module was a calculation for outpatient medication script support, which showed a remarkable increase in assessment scores following a self-directed information module. Future planned modules are centered on anticoagulation agents and diabetes topics. APPE students developed these modules during clinical experiences.
How have you made this service sustainable? (Include billing, reimbursement, etc.)
Discussions surrounding sustainability have been centered on work relative value unit (wRVU) capture. Pharmacist are not recognized as a billable provider in the state of Florida which poses some barriers to compensating for a salary offset, so collaborative models are used. A recent project has been conducted tracking wRVU-comparing physicians who collaborate more regularly with the pharmacy service for level of service impact and quantity variations. After reviewing a random sample of approximately 625 records, loosely interpreted, physicians that work more collaboratively with the pharmacist team on average had a higher wRVU average and number of patient seen per day. This can be extrapolated to assume that the pharmacy service is managing the chronic medical states that allow the physician to see more complex, higher wRVU cases addressing acute needs. Additionally on average four more patients were seen per day when working collaborative, which lends to a discussion of increase in patient care assess. Additional work is needed in this area to continue expansion of pharmacy collaboration into other models of practice.
How did you gain support of administrators, providers, and other key stakeholders to implement your practice model?
The clinic model was initiated several years ago and an additional pharmacist was added more recently due to increased workload. Metrics have focused on tracking, improving, and expanding reach.
What are some lessons learned while implementing your practice model that you would like to share with other pharmacists?
Simple thoughts: focus on building relationship with your practice partners, avoid functioning in a silo, do your homework, research, and share the victories.