2022 Midyear Conference
September 14 - 16
The Omni Parker House
Boston, Mass.
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Presentations
Thursday, September 15
Project US@: A Unified Technical Specification for Patient Address
Carmen Smiley, Information Technology Specialist (Systems Analysis), Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services
Did you know that up to 60% of our health is determined solely by our ZIP code? ZIP code is also the greatest predictor of life expectancy. At the same time, approximately 26 million patients receive their medications by mail each year. These are only a few reasons why we should make every effort to ensure that we have the most accurate and up-to-date address information for every patient, no matter who they are or where they live. Project US@ represents unified, cross-standards technical specifications and operational guidance for representing patient address in healthcare to improve patient matching. Patient matching is a challenge across every segment of healthcare, including pharmacies, pharmacy benefit managers, payers, and prescription drug monitoring programs. Carmen will provide an overview of the background, purpose, and progress made so far on Project US@, and outline recommended next steps to encourage adoption and implementation of the technical and operational guidance and best practices.
Open Data Quality Assessment Framework
Naresh Sundar Rajan, Ph.D., Chief Data Officer, CyncHealth
Tom Novak, Senior Advisor, Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services
Carmen Smiley, Information Technology Specialist (Systems Analysis), Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services
As the opioid crisis continues to worsen, the interoperability of prescription data between disparate systems has become a critical need for effective monitoring and treatment. Poor data quality inhibits patient matching and record linkage that supports interoperability, analytics and reporting, machine learning and artificial intelligence, and business processes such as prior authorization and billing. Even the most advanced algorithms are unable to overcome poor data quality entirely, and many health IT (information technology) systems rely on third-party services or applications to scrub and normalize data, imposing additional costs and other burdens. This presentation will discuss a unique approach to enhance patient matching for prescription drug monitoring program (PDMP) data exchange. Employing evidence-based design principles, the panel reused an existing open health data quality framework and collaboratively built an inclusive data quality framework that can be applied to PDMPs across the nation. The framework was developed on the ASAP Standard for Prescription Drug Monitoring Programs Version 4, Release 2A Implementation Guide, though it could be expanded to support other standards. The framework is data-driven, modular, free and open source, flexible, and consensus based. The presentation will provide an overview of the framework and present pilot testing results from two state PDMPs. This approach supports Section 7162 of the Support Act that authorizes federal funds for specific prescription drug monitoring program improvements regarding use, data reporting, and intra-state and interstate interoperability directly impacting public health outcomes and policy decisions.
An Overview of the Pharmacy and Medically Underserved Areas Enhancement Act
Ann Johnson, Pharm.D., President of Pharmacy Healthcare Solutions, LLC
Ann will provide an overview of the Pharmacy and Medically Underserved Areas Enhancement Act. This bipartisan legislation would recognize pharmacists as healthcare providers in medically underserved areas, allowing them to be reimbursed for providing specific healthcare services under Medicare Part D. The presentation will provide an overview of the act, review sponsors of the bill, discuss parallels with reimbursement for other non-physician practitioners, and share predictions for the future.
Provider Status and Digital Pharmacy: A Winning Combination for Patient Care and Labor Challenges
Christopher Fortier, Pharm.D., FASHP, Chief Pharmacy Officer, Massachusetts General Hospital Department of Pharmacy
In response to this worsening primary caregiver shortage, Congress introduced the Pharmacy and Medically Underserved Areas Enhancement Act, which would give pharmacists provider status under Medicare Part B. This would allow them to be reimbursed for providing more services like medication therapy management, immunizations, point of care testing, chronic disease management, and much more. This will provide financial incentives to position pharmacists in higher-value tasks in the ambulatory setting. Evidence shows that pharmacists make a significant impact on patients' health outcomes and reducing healthcare costs. Pharmacist provider status would align reimbursement with pharmacists' services and give underserved patients more access to crucial care.
Chris will focus on how automation and artificial intelligence will play a critical role in allowing pharmacists to refocus their time on more patient care activities. For example, clinical pharmacy services can be augmented by reducing the time spent on administrative or drug distribution tasks. Furthermore, advanced analytics can help prioritize clinical activities. Using artificial intelligence can prevent high-risk patients from developing medication complications. Utilizing AI enables proactive medication management versus a reactive approach. The pandemic highlighted the critical role automation and intelligence play in assisting pharmacists in providing more value in the healthcare system. Data is essential to provide more efficient inventory management and optimize clinical outcomes based on patient-specific decisions.
Friday, September 16
The State Legislative Update and Outlook
Scott Pace, Pharm.D., J.D., Partner, Impact Management Group
Scott will provide a look at the key pharmacy-focused legislation that has been moving through the states in 2022 and what to expect in 2023.
Medicare Part D and Pharmacy DIR Final Rule: What You Need to Know
Steve Postal, J.D., Director of Policy and Regulatory Affairs, National Community Pharmacists Association
Join Steve Postal as he highlights the key takeaways from the Centers for Medicare & Medicaid Services’ final rule on the Medicare Part D final rule and its pharmacy DIR (direct and indirect remuneration) component, the rule’s impact on community pharmacy, and where we go from here.
PDMP Recommendations for the Next ASAP Version
Kevin Borcher, Pharm.D., Vice President, Pharmacy Informatics, CyncHealth
Every state prescription drug monitoring program uses and has relied on the ASAP standard format for the reporting of dispensed controlled substances and other prescriptions. Much has changed since the last version was released in 2020. Kevin will present the recommendations made by state PDMP administrators to keep pace with the ever-changing healthcare environment and state and federal legislation.
Healthcare Initiatives and Big Tech: A Roundup
Marsha Millonig, M.B.A., B.Pharm., President and CEO, Catalyst Enterprises, LLC
Marsha will review the current healthcare-oriented initiatives at major global tech companies. Find out what Big Tech projects have been shelved and what new initiatives to keep an eye out for.
Speaker Bios
Carmen Smiley is an Information Technology Specialist (Systems Analysis) in the Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services. She is ONC’s subject matter expert in patient identity and matching and the technical lead on pharmacy interoperability. Prior to joining ONC, she was the Quality Assurance Coordinator at Children’s National Medical Center. Carmen was also on the Meaningful Use National Team at the US Indian Health Service, where she focused on performance measures, public health reporting, and related initiatives. Much of her 26-year career has been in international public health research of children and adolescents across Latin America and Sub-Saharan Africa. She is the recipient of the Rising Star, Excellence in Innovation, Excellence in Outreach, and Excellence in Follow Through Award, as well as the Deputy National Coordinator Award and the National Coordinator Award at ONC, and she is an Excellence in Government Fellow.
Naresh Sundar Rajan, M.S., Ph.D., is Chief Data Officer at CyncHealth. He currently leads CyncHealth Data and Analytics, focused on modernizing data strategy towards enhanced interoperable systems. He also serves as chairperson of the Technical Architecture Subcommittee for Prescription Monitoring Information eXchange (PMIX) Standards Organization’s Technical Architecture Committee and on Project US@ that aims at developing standards for United States address metadata for patient matching. Naresh leads ONC’s pilot project in U.S. standards for address matching to enhance patient-matching algorithms and develop standard metrics to compare across multiple standards. He received his Ph.D. in medical informatics from the University of Utah and holds a B.S. in bioinformatics and an M.S. in computer science from Fairleigh Dickinson University.
Tom Novak is a Senior Advisor on State and Medicaid Policy for the Office of Policy in the Office of the National Coordinator for Health IT where he supports the advancement of Medicaid interoperability in the drafting and review of Federal regulations. He works closely with the Centers for Medicare and Medicaid Services – Medicaid Data and Systems Group – where he provides direct support to state Medicaid agencies and state governments on Health Information Exchange funding and strategy.
Ann Johnson, Pharm.D., is a consultant for research and innovation and a partner at Pharmacy Healthcare Solutions, Inc. (PHSI), where she began working in 2010. Ann works on a variety of projects, with a current emphasis in analytics and pricing reimbursement, financial models, drug compendia review and product launch support, indirect manufacturer contracting, contract review, 340B program assessment and auditing, PBM RFP support, policy and procedure writing and review, and market research. She has experience in independent retail pharmacy as well as specialty, clinical, industry, and ambulatory care pharmacy.
Christopher Fortier, Pharm.D., FASHP, is Chief Pharmacy Officer, Massachusetts General Hospital Department of Pharmacy. He is responsible for the management for all aspects of Mass General’s pharmacy enterprise including all inpatient and ambulatory pharmacy services both on and off-campus and for over 400 employees. Additionally, Chris chairs the Mass General Brigham Chief Pharmacy Officer’s Council and is responsible for leading large-scale pharmacy initiatives at the health-system level. Chris received his Pharm.D. from the University of Connecticut School of Pharmacy and completed a PGY-1/PGY-2 Health-System Pharmacy Administration Residency at the Medical University of South Carolina Medical Center in Charleston, South Carolina.
Scott Pace, Pharm.D., J.D., is a partner at Impact Management Group where he focuses on the Government Relations and Public Affairs practice areas. Scott joined IMG following more than 12 years with the Arkansas Pharmacists Association (APA), most recently serving as the organization’s executive vice president and CEO. Scott holds a B.S. in biology from Arkansas State University, a Pharm.D. from the University of Arkansas for Medical Sciences, and a J.D. with high honors from the University of Arkansas at Little Rock William H. Bowen School of Law. He served as the consumer representative on the Arkansas State Medical Board from 2012-2015 and he serves on the Arkansas Prescription Drug Monitoring Program (PDMP) Advisory Panel.
Steve Postal, J.D., is the Director of Policy and Regulatory Affairs at the National Community Pharmacists Association (NCPA). His areas of expertise include Medicare Part D, compounding, and long-term care pharmacy. Before joining NCPA in April 2022, he worked for the American Physical Therapy Association in federal regulatory affairs. Prior to that, he worked for the Pharmaceutical Research and Manufacturers of America (PhRMA) in state affairs, and for the law firm Powers Pyles Sutter & Verville in federal regulatory and legislative health policy. He received his B.A. in history from Bowdoin College and his J.D. with a concentration in health law from Case Western Reserve University School of Law. He is a member of the Maryland and District of Columbia bars and serves as a vice chair of the editorial board for the American Bar Association’s Health Law Section.
Kevin Borcher, Pharm.D., is the Senior Director, Pharmacy Services and the Prescription Drug Monitoring Program (PDMP) Director for Nebraska at CyncHealth. In his role, he is responsible for coordinating the operations and enhancements of the PDMP and serving as the primary liaison between CyncHealth, professional associations, member organizations and stakeholders in relation to data collection, training, and publicity.
Marsha Millonig, M.B.A., B.Pharm., is the president and CEO of Catalyst Enterprises, a healthcare consulting firm dedicated to creating change. It specializes in projects that allow pharmacy, distribution, and manufacturing clients to be more efficient and value-added providers toward improved health outcomes. She is a practicing pharmacist and pharmacist immunizer, working with both independent and chain pharmacies.