San Diego Right Care-GOLeadership Forum on the Prevention of

Heart Attacks and StrokesJune 4, 2010

Daniel Cusator, MD, MBA Rebecca Cupp, RPhChief Medical Officer VP of Pharmacy

Greater Newport Physicians Ralphs Grocery Company

Disruptive Innovation:◦ Unexpected new offering through price or quality

improvement that turns a market on its head.

Benefit of using Appropriate Skill Level

PhysiciansNursesClinical

PharmacistsPhysician

Assistants

Nurse PractitionersMedical AssistantsSocial WorkersTechnicians

Making the case for clinical pharmacists as part of the health care team

Pharmacy profession has been moving from a product- focused to patient-focused practice

The Asheville Project ◦ Recognized as a promising intervention for rapid improvement in C/V Dz

Including pharmacists on the care team can provide better outcomes ◦ Kaiser Permanente (early 1990’s) study: improved survival and

decreased hospitalizations

◦ Planas, 2009-Improving BP Control in DM HTN patients

◦ de Oliveria, 2010- MTM ROI $1.29 per $1.00 MTM Costs

IPA Group In-House Pharmacist

Academic Clinic Pharmacist

Community Pharmacist

Imbedded Clinical Pharmacist

◦Supports Specific Group Practice

◦Continuum of Care for Practice Population

PharmD-MD Collaborative Usual Care

• Internal Medicine Group – UCSD • HTN patients• Collaborative Practice Protocol• MTMS activities• Clinic visits and follow-up phone calls

RCI Demonstration Project

Medication Therapy Management Services (MTMS)

◦Drug therapy initiation and monitoring◦Medication dosage adjustments◦Physical assessment◦Laboratory test review/order◦Patient Education

Measurable Outcomes

Standardized Pharmacist Coaching Program

◦Initial Visit

◦Follow Up Visits

◦Documentation

Patient Care Services

◦Medication Therapy Management

◦Point-of-Care Testing

◦Patient Education

Benefits◦Accessibility◦Familiar and comfortable environment

◦Convenience Location Hours

◦Measurable Results Improved Scores