Oregon pays pharmacists for all services under scope of practice

Alis Volat Propriis—“She flies with her own wings”—is Oregon's state motto. The government first adopted the slogan in 1854 as a hat tip to independent spirit of pioneers who formed government. was replaced by others over years until lawmakers brought it back 1987—arguing that still reflected traditions independence and innovation.Oregon pharmacists have come embody those traditions. has recognized providers since 2009. But, many other states know, provider status alone does not always give authority exercise their full scope practice or autonomy bill for services. Laws enacted Oregon 2009 further empowered use expertise provide best care patients. Fair reimbursement this both public private payers made clinical pharmacy services sustainable part offerings at clinics across state.“It's exciting be place where you're able do more your patients,” said Ucheoma Nwizu, PharmD, pharmacist Neighborhood Health Center Portland.Laws on sideIn 2003, legislators passed allowed clozapine monitoring. In 2005, legislature expanded pharmacists’ billing drugs required monitoring beyond clozapine. By 2009, they could medication therapy management Then, 2015, landmark law cover any profession's practice.“These laws paved way start building practices like provider,” Andrew Hibbard, ambulatory coordinator CareOregon, coordinated organization.Laws books also prohibit from discriminating against basis profession. Discriminatory pay is prohibited, too. Payers must reimburse same rate clinicians get service.Some plans specialist visit. Others visit would another primary provider.The last decade measures increased pharmacists, For example, may now recommend services, such management, directly patient. They rely referrals physicians providers.Care coordinatorsAfter go into effect expand authority, can take catch up on.“Provider really an unknown thing pharmacists,” Hibbard said. “They don't understand it.”Many are no different.When Clinic began working embedded sent out credentialing requests payers. “Some them got us ‘We've never done before. Let's think about it’ ‘Let's talk it.’ Some were board, some us,” Zach Rosko, director teams Portland.But, Rosko added, “It shocking how people right off bat just said, ‘Yes, absolutely, we'll pharmacists,’ I'm talking commercial plans.”CareOregon stepped bridge knowledge gaps among when comes care. Through organization's Pharmacists Collaborative, which runs, CareOregon helped embed 125 credentialed contracted state.“There's lot room grow areas our network access manage complex diseases, diabetes heart failure,” said.And there's good reason push these patients, CareOregon's extensive internal research shows patients type 2 diabetes, well polypharmacy, better outcomes clinic systems employ pharmacist.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Disease specialistsAt Oregon, chronic disease specialists.“Here, recommendations defer conditions,” Vivian Ton, lead Central City Concern, federally qualified health center downtown Portland. collaborative drug anticoagulation therapy, hepatitis C, hypertension, dyslipidemia, COPD, asthma, pre-exposure prophylaxis HIV.Among Ton's man 1 had already one leg toes foot amputated before becoming struggles keeping his blood glucose levels regulated because he lives fear hypoglycemia. It taken education make him comfortable level. After year, Ton patient substantial progress.“In middle visit, broke down saw A1C wouldn't here if weren't me,” said.The noted visits check-ins, whereas longer frequent appointments learned disease.“Our model allows one-on-one said.At Center, gives time unravel distinct problems each patient, young woman cared Nwizu. mid-20s, emergency department frequently A1Cs high 15%.At meeting, Nwizu read patient's chart she mother, caregiver, intellectual disabilities. But clear case.“They poor literacy,” co-resident time. needed little bit attention than you typical visit.”Over next 12 months, under Nwizu's care, woman's fell 15% 6.2%. streamlined regimen 18 medications six prescribers four pharmacies 9 three pharmacy.“Pharmacists wave magic wand,” very rewarding goal, but took hard work.”Both only give.The meaning accessibilityIn treated paid provider, will availability accessibility continue strengths? Or days, too, fill hurried, back-to-back 15-minute visits?Ton, that's work.“Disease targeted approach,” “We problem-solving motivational interviewing around condition, while bombarded different things 20-minute visit.”Because after undergone work-up received diagnosis, ground allotted It's relay diagnosing sprinted baton far track. Then remaining—often long—distance finish line.“This teamwork,” “and makes pretty seamless.” innovation. state. “It's providers. practice. “These organization. service. provider. Care pharmacist. on. “Provider it.” Many different. When plans.” “There's And Disease give. At specialists. “Here, HIV. Among progress. “In disease. “Our 15%. case. visit.” Over pharmacy. “Pharmacists work.” Both visits? work. “Disease Because line. “This