Making Your Pharmacy Practice Department “In-dispense-able”

To the Editor. Pharmacy practice departments are responsible for the majority of experiential training within a doctor of pharmacy curriculum. Innovative practice is a critical component of this educational experience. Development of innovative practice opportunities can serve multiple purposes for a pharmacy practice department, in addition to promoting unique practice environments for pharmacists.

At the same time, the economy is putting increased pressure on pharmacy school resources. Cohen described the need for innovation and entrepreneurship in pharmacy programs, illustrated by a number of opportunities which include identifying new revenue streams and developing joint ventures or partnerships.¹ In the Pharmacy Practice department at Creighton University School of Pharmacy and Health Professions, we have developed unique relationships within our university and community that allow for innovative practice opportunities and a chance to demonstrate that the department is “indispensable.”

Opportunities for Innovation

Creighton, like many other universities, provides healthcare benefits to employees through a self-insured model. Recently, a focus of consumer-driven healthcare has been undertaken. This has presented a number of opportunities for collaboration between our practice faculty members and the university's human resources department.

Implementation of a more sophisticated prescription benefit design for the university provided an initial opportunity to introduce administration to the advantage of including the pharmacy program perspective in this process. Using pharmacy faculty members with managed care experience, guidance was provided in the process, resulting in the successful implementation of a significant benefit change. This implementation has positively impacted the university from a financial standpoint, resulting in health insurance premiums remaining unchanged the following year. In a time of ever-increasing healthcare costs, this is a considerable accomplishment. In addition, the development of this relationship also resulted in a faculty member being named as a formal liaison between the School of Pharmacy and Health Professions and the human resources department. This liaison is actively involved in the ongoing maintenance of pharmacy-related benefit issues, including serving as an internal clinical point person with the pharmacy benefits manager. A pharmacy benefit advisory group is coordinated by the liaison, which allows medical faculty members, pharmacy faculty members, and human resources administration to come together and discuss appropriate strategy and management for the university's drug benefit decisions.

In 2008, the pharmacy practice department and the human resources department collaborated to create an innovative employee health program to target the most costly chronic conditions of our organization. Health risk appraisal and medical claims data indicated that cardiovascular disease, the risks leading to cardiovascular disease, and the medications associated with these risks were placing a heavy financial burden on the university. An innovative program was developed and is being delivered by the pharmacy practice faculty that targets employees with diabetes, hypertension and dyslipidemia. The program combines medication therapy management with individualized lifestyle medicine programs and care coordination.^2,3 Outcomes data collected to date indicate that the university is saving over $2000 per participant per year in health care expenditures and demonstrates a 4:1 return on investment. To expand the program, human resources and our pharmacy practice department have jointly funded (50/50) a new full-time faculty position to carry out these programs. The pharmacy practice department is currently working with corporations outside of the university to establish contracts to replicate the pharmacist-run employee health program to advance the practice of pharmacy and as a source of revenue for the department.

The time investment by our faculty members in these endeavors has resulted in cost savings to the university, which in turn translates into lower healthcare costs for all employees. In addition, the development of these unique practice models provides opportunities for revenue development in the department.

Another unique opportunity for our pharmacy practice department has been the establishment of a relationship with a local physician hospital organization (PHO). This PHO provides managed care services to 6 hospitals in the metropolitan area. Our Center for Drug Information and Evidence-Based Practice, within the department, provides a number of drug information-related services to the PHO, in an effort to promote appropriate pharmacotherapy. A continuing medical education-accredited newsletter is developed and published by drug information faculty members and students approximately 8 times per year, and distributed to over 1000 physicians in the area. In addition, a pocket card highlighting local formulary treatment options for the major managed care carriers in the area is maintained by faculty members and published twice per year. Both of these services are widely appreciated by the PHO, and offer our department an opportunity to introduce the medical community to the unique benefits a pharmacist can provide in practice. Based on this relationship, discussions to integrate pharmacy practice faculty members into a patient-centered medical home model are currently underway.

Through introductory pharmacy practice experiences, our department has formalized a community service relationship. Both our faculty members and students participate in health promotion activities in a variety of settings, educating the public and expanding their view of what pharmacists can do. In this way, we achieve a degree of recognition for pharmacy as a patient-centered profession.

In summary, we need to be our own advocates and advertise, through actions, who we are and what we can do as healthcare professionals. Through expanding our service and visibility on campus and in the community, our department has justified our position on campus and achieved a degree of “indispensability.”