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Disruptive Healthcare

February 7, 2020

by Myriam Shaw Ojeda, Pharm.D.

What is the meaning of a disruption? I like to visualize this word as a calm ocean floor that is interrupted by a speeding sea creature. Eventually, the waters may settle down, but the sandy ocean bed is never the same. I share this imagery because there is a disruption on the horizon in pharmacy. This change in practice began with the passage of Pharmacy Provider Status into law in Ohio. Many pharmacists look at this shift with suspicion, wondering if this will affect them. But I can assure you that the change ahead will influence the landscape of pharmacy forever.

Recently, Ernie Boyd, Stu Beatty, and I visited the Cedarville University School of Pharmacy on behalf of the Ohio Pharmacists Association (OPA) to present a town hall on the most recent updates on Provider Status. For the non-pharmacists reading this blog, that of Ohio passed the Provider Status bill (SB 265) in January 2019. It recognized pharmacists as providers across the Ohio Revised Code. This means that pharmacists can now access additional revenue by billing for broadened services that they can provide. Because of this law, Ohio is at a unique point in pharmacy history to change the practice of pharmacy.

The Need for Change

How did we get to this point of change? First, healthcare has gradually moved from fee-for-service to a value-based care model. This means that insurance providers must now reimburse based on the outcomes patients achieve after a procedure rather than a list of services provided. Pharmacists are well-positioned with their educational training and interaction with patients to fulfill the needs that result from this new healthcare model.

Additionally, the Provider Status bill that was passed in 2019 allows pharmacists to provide billable services. Research has repeatedly shown that pharmacist intervention has led to improved patient care and better health outcomes.

Finally, the current scenario in healthcare does not favor patients. Increasingly unaffordable medication and pharmacy reimbursements have affected patients’ access to quality care and have financially jeopardized the pharmacies that serve them. The state of Ohio has had unprecedented media coverage that has highlighted the broken insurance system and a need for change.

Implementing Provider Status

So, where does OPA come into the picture? We are seeking practical ways to implement Provider Status. A core team of staff, shared faculty, and Pharmacy Fellows are currently in advanced talks with payors to roll out pilot programs. A taskforce of pharmacists with diverse pharmacy representation from across the state has been tasked to help with the practical needs of this initiative. Lastly, visits to pharmacy schools will help to spread the news about Provider Status to students, faculty, and other pharmacists associated with these schools.

We need informed pharmacists who will educate people in the meetings and staffrooms where we cannot even dream of entering.

There is a lot to be done to make Provider Status a reality, and OPA can only go so far with its efforts. In order to implement this change across the state, we need you. Consider this your call to action.

A Call to Action

First, we need informed pharmacists who will educate people in the meetings and staffrooms where we cannot even dream of entering. You have the power to be an advocate and share your knowledge. You can be better informed on this change by keeping yourself up to date on what pharmacists can do and have done. OPA’s annual conference from April 3-5, 2020, will have educational sessions on Provider Status that can help update your knowledge.

Next, OPA has a Pharmacy Services Survey where you can share information about your practice site and what services you provide. We would like to have a database of pharmacists and pharmacies who would be available in the event a pilot program is needed. Lastly, use the power of social media. OPA has a hashtag for provider status #OHprovideRx. When you think of times where you provided care, share about it. Stakeholders, policymakers, and other healthcare providers will be able to see the difference you make for the patients you serve.

In closing, we made provider status happen with many pharmacists who stepped in and provided the insight, testimony, and time needed to pass the Provider Status bill into law. We can’t take this next step without you. Join us as we look to make Provider Status a foundational step on the way to healthcare transformation.

Myriam Shaw Ojeda is an alumna of the Cedarville University School of Pharmacy. She serves as the Fellow for Policy and Innovation at the Ohio Pharmacists Association. Cedarville’s School of Pharmacy combines academic excellence in pharmacy with a distinctly biblical worldview. Its Pharm.D. program is equipping pharmacists to honor God as they serve as excellent pharmacists wherever He leads them..

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