Mike Hennessy, Chairman/Chief Executive Officer

The push for provider status for pharmacists has generated tremendous support and cohesion among pharmacy and nonpharmacy stakeholders. Associations representing pharmacists have expressed overwhelming support for the provider status bill (HR 4190), which would define pharmacists as health care providers under Medicare. And the stage has been set for the bill to become law. The majority of US representatives who cosponsored legislation supporting provider status were reelected to Congress on November 4, according to a 

If the bill becomes law, it will grant pharmacists greater federal recognition as members of the health care team. But is the profession ready for the new challenges that provider status would bring?

“Getting provider status is not an end goal unless there is a scope of practice in place that allows an expanded role for pharmacists,” says Fred M. Eckel, RPh, MS, ScD (Hon), 

. Scope of practice is determined by the states and varies greatly among states; therefore, state pharmacy associations must remain a strong voice for pharmacists.

Equally important will be the need for funding to pay for new pharmacist-delivered services allowed by the law. “That is why there are now state-level initiatives around pharmacist provider status developments,” says Eckel. Brian Bray, PharmD, CPP, describes how provider status and entrepreneurial efforts by pharmacists could expand their scope of practice and help them receive adequate compensation for services (see his article on page 27).

In addition, with their movement toward provider status, pharmacists are facing the new challenge of entering a marketplace where there are already other providers. “As the resources to support patient care don’t grow to the extent that we need them to, we’re going to have to take on some other providers and challenge them to see how we can collaborate with them,” says Eckel. Without a change in the current business model, “Pharmacists will continue to have limited time to counsel patients and effectively manage their drug therapy,” says Krystalyn Weaver in her article on page 25.

Achieving provider status will be considered a big win for the profession, but are you ready for the challenges it will bring? Let us know your thoughts on Facebook and Twitter (@Pharmacy_Times).

In this final issue of the year, we would like to take the opportunity to wish you and your families a very happy and healthy New Year! 

 will be here to help you stay ahead of changes in the health care landscape.

Articles

Provider Status Will Bring New Challenges

 has an interesting history, and it is on the top of everyone’s mind. Called 

 in the past, the use of this particular word seems to lay the blame of medication misuse and non-use at the feet of the patients. As our editor-in-chief suggests in this issue, noncompliance has been a problem looking for an owner. 

Today, we know that patients taking their medications correctly—or not taking them at all&mdash;is still a major problem and contributes to the overall rising costs of health care. Prevention, adherence, and patient buy-in for their own health are all necessary components for successful adherence. 

 explores the cutting-edge ways pharmacists and other health care professionals are stepping up and turning adherence into a movement. We present a compelling article on an innovative pilot program written by Jon Easter, BSPharm, RPh, senior director of delivery and payment reform at GlaxoSmithKline, which discusses what can be done and what is being done. At GSK, he has championed the company’s involvement in North Carolina’s “First in Health,” one of the nation’s leading patient-centered medical home projects, described in this issue.

As Jon says, “Pretty soon, pilots will be evolving into mainstream practice. That is transformation. And the best part—it’s the patient, your family and mine, who will benefit the most. If you haven’t already, it’s time to jump in&mdash;the water is warm.”

Other leaders in pharmacy share their progressive insights into adherence, and they offer a wealth of perspectives. From technology to quality measures to an accountable care perspective “from the trenches,” you’ll find this issue great reading.

We also invited James Fries, MD, a pioneer in preventive health and wellness, to be the keynote speaker at our 2014 Next-Generation Pharmacist

 Awards gala this month in Boston and to contribute to this issue. Dr. Fries is a professor of medicine, immunology, and rheumatology at Stanford University School of Medicine, and is a nationally known and respected expert on long-term patient outcomes. He has authored more than 300 articles, numerous book chapters, and 11 books, including 

Dr. Fries is perhaps best known for his “compression of morbidity” hypothesis, which holds that the burden of lifetime illness may be compressed into a shorter period before the time of death, if the age at the onset of the first chronic illness can be postponed. His article, “Living Well: The Science of Postponing Aging” (beginning on page 6) introduces his theory and how best to achieve it—and he suggests ways pharmacists can contribute to the delay of aging in the patients they touch.

“The pharmacist is ideally placed to effectively address behavior and lifestyle issues that can contribute directly to improved health outcomes,” says Fries.

This issue of Directions in Pharmacy explores the ways in which pharmacists and other health care professionals are turning adherence into a movement.

The Medication Adherence Movement

You’ll get just about everyone’s attention with the terms “value-based” and “value-driven”—and what first comes to mind are the literal cost savings in dollars and cents. In health care today, this vocabulary surfaces in just about every discussion about health care and in every setting, from medical practices to hospitals to pharmacies. With the implementation of the Affordable Care Act in progress, cost savings have not yet been realized as the health care community adjusts to new realities and regulations. 

 addresses the value-based health care model through the eyes of pharmacy—and focuses on its challenges and opportunities. While all medical professionals are affected, perhaps pharmacists are the key to its potential success because if, and only if, medication adherence is achieved on a global scale will health outcomes be positively affected and those all-important dollars be saved down the line.

Things are changing rapidly in health care, and as our guest editor Troy Trygstad, PharmD, PhD, MBA, notes, “That paradigm is changing dramatically now that stakeholders are choosing a wider-angle view resulting from health care reform’s shared risk corridors and emphasis on value over volume.” The pharmacist—whether from a community, health-system, or specialty pharmacy setting&mdash;is in the unique position of being able to perhaps effect the greatest amount of change, and, ultimately, cost savings. Collaboration among the entire health care team, which is evolving in the new value-based models of care delivery, showcases the special value and talents pharmacists bring to the process. 

So, how do you define value? Dr. Trygstad says, “Value is defined as the amount of benefit received for the cost relative to other services that produce similar benefits. Yet for the vast majority of health care services, 

the benefit isn’t realized until after the encounter.

 Thus, follow-up, adjustment, and reinforcement of the patient’s care plan are essential for realizing the benefits coming from the investment made by the patient or the payer in the encounter.”

What he says makes sense in today’s environment. It’s all about the patient and the patient’s continued experiences with all members of the health care team. And pharmacists’ expertise in medication management, plus their accessibility in the community, point to an ever-expanding role for the pharmacist in the health and wellness of the nation’s population.

This edition of Directions in Pharmacy addresses the value-based health care model through the eyes of pharmacy-and focuses on its challenges and opportunities.

How Do You Define Value in Health Care?

 we have been pleased to bring you deeper insights into the way health care is evolving for the entire health care team—and especially how the role of the pharmacist has changed and will continue to change as new delivery models take hold. As we continue this important discussion in 2014&mdash;bringing together experts who have successfully addressed the tough issues&mdash;I invite you to look to 

 series for the most relevant, most timely, and most provocative coverage of this very significant time in our nation’s health care history.

Getting connected is the theme of this issue as we explore the various ways pharmacists are already working to take advantage of the innovations in health information technology. We also look at key trends to watch and look at what entrepreneurial pharmacists can accomplish in this new health care landscape. Taking on the challenges—and taking risks&mdash;is the wave of the future as accountability, quality, and access become important touch points in the new health care landscape for all heath care professionals.

Within this issue, you learn about how “Big Data” can impact costs and improve patient care dramatically once its secrets are unlocked. And as your patients utilize more and more mobile tools to access their records and health care planning needs, pharmacists need to be plugged in and ready to help improve outcomes. 

Within this issue, you learn about how "Big Data" can impact costs and improve patient care dramatically once its secrets are unlocked.

Perspectives in Pharmacy

The buzz words say it all—“care coordination”&mdash;and together these 2 words sound as if it should be relatively easy to “coordinate the care” of patients across health care teams and locations. It should be simple to share information about a patient and come up with the very best way to treat him or her. Naturally, savings will start pouring in as soon as everyone on the health care team just works together. Right?

Not so fast. The conundrum is access to current patient records, communication between health care professionals, access to medications, medication reconciliation, and the list goes on and on. It simply doesn’t all happen so easily and efficiently in today’s health care system in the United States.

, under the guidance of our guest co-editor, Troy Trygstad, PharmD, PhD, MBA, and Editor-in-Chief Fred M. Eckel, RPh—we address the new health care landscape head on and zero in on how the pharmacist fits in and 

In this edition, which focuses on Care Coordination, we share some honest and insightful discussions about how care for patients actually works and how it can work in a variety of settings. Some innovative pharmacists are leading the way, and with this series we showcase their efforts. You’ll see a variety of perspectives that we hope will inspire and enlighten.

While defining this new landscape within our special supplement series, we also keep an eye out for what people are saying about accountable care organizations, the Affordable Care Act, and how they are affecting the pharmacy profession as a whole. The chair of the department of clinical practice at the UCSF School of Pharmacy, for example, says “We are building new ways for pharmacists to improve patient health—and even lower costs&mdash;to prepare students for what is truly a new day of pharmacy practice.” This “new day” is reflected this comment as well: “We’re in the era of ACOs, an era where whoever is providing health care is going to need to take responsibility for outcomes and costs across the spectrum of care,” says ASHP Chief Executive Officer Paul Abramowitz, PharmD, FASHP.

One of the recurring themes you’ll read in this 

 issue is the rising cost of health care and how the coordination of care will—and does&mdash;make a huge difference in both the outcomes and the cost of that care. As Dr. Abramowitz says, those individuals providing the care will need to take responsibility for the results and the costs&mdash;all within coordinated efforts in a new model of care delivery.

Accountability, responsibility, and saving costs. Important goals for all concerned—and that includes the health care professionals on the team, as well as, in my opinion, the patient himself. Pharmacists are ready, able, and willing to participate in this new world and they should be included every step of the way.