The Pharmacy Profession in
Minnesota 2013
Marilyn K. Speedie, Ph.D., Dean
University of Minnesota College of Pharmacy
Over the past 20 years, drug therapy has
become more complex:
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More medications per patient
More complex medications available
More types of prescribers
Drugs purchased over the internet; mail order
More physician specialists seen per patient
The pharmacist is the best health care
provider to manage these drug
complexities.
Modern pharmacists are prepared to provide
medication management to optimize health outcomes
• All Minnesota pharmacists who have graduated
since 1996 are educated to provide direct patient
care that gets desired results from medications.
• Medication management (or MTM) involves the
identification and resolution of all drug related
problems.
• Every $1 invested in a pharmacist = $3 to $10
savings in overall health care costs.
Pharmacy: This Is Our Time
• Pharmacists are well-positioned to play a major role in
health reform.
– Pharmacists are the most accessible health care provider:
275 million Americans visit a pharmacy per week.
– 80% of patients receive prescriptions for at least
one drug; drug therapy is the most cost-effective
mode of treatment.
– Pharmacists have proven value and have expanded
their roles on the health care team, especially in
meeting primary care needs.
– MN is leading change as to where and how
pharmacists practice and in documenting positive
financial and health outcomes.
Pharmacists have many years experience
with providing medication management to
Minnesotans.
• Since 2006 Minnesota DHS has paid for medication
management for Medicare patients with 2 or more
chronic diseases and/or 4 or more medications.
• Medication management results in improved therapeutic
outcomes as well as physician and patient satisfaction.
Some pharmacists prescribe under the collaborative
practice provision.
• Medication management can be performed as part of a
medical home/clinic; home health (MVNA); or in a
community pharmacy setting.
Pharmacists in Healthcare in MN
• Pharmacists are increasingly involved in transitions
of care but transitions are very complicated since
they often involve changes in medications and
changes in the health system/ pharmacy/
physicians, etc., who are caring for the patient.
Data shows a dramatic reduction of readmissions
and ER visits when pharmacists are involved in
transitioning care.
• Use of electronic records, connecting all health
professionals, is growing, but is insufficient at this
time to optimize use of pharmacists in the
community.
Example: Pharmacists in
Transitions of Care
Minnesota Visiting Nurse Agency (MVNA):
• 30% reduction in re-hospitalizations
• 50% reduction in Emergency Department visits
Hennepin County Medical Center (HCMC):
• Increased primary care visits vs. Emergency
Department for high risk populations
Health care reform will dramatically
affect how pharmacists practice
Pharmacists are increasingly being asked to use the full scope
of their strong clinical skills AND to:
• participate in collaborative care settings, in
interprofessional teams,
• help lead change in the new health systems,
• contribute to achieving the “triple aim” (lower cost, better
health, improved patient experience) that is the goal of
health care reform,
• be part of “pay for performance” systems
• and use technology effectively.
Overview of College of Pharmacy
• Four year Doctor of Pharmacy degree program is
the only program for the preparation of pharmacists
(true all over the US)
• 640 Doctor of Pharmacy students on two
campuses, Minneapolis and Duluth (both University
of Minnesota campuses), connected by interactive
television
• Extensive on-line e-learning courses for
pharmacists, undergraduate students and other
health professions.
What were the dimensions of the
pharmacist shortage in 2000?
• COP and DOH surveyed rural practitioners and
Twin City hospital directors
• Appeared to be 200 to 400 openings
• Caused by increase in number of prescriptions,
aging population, pharmacist retirement, new roles,
and too few grads
• New technology didn’t relieve need
• Impact most acute in rural communities; losing
pharmacist services altogether
What is the impact of a pharmacist shortage?
• Overworked pharmacists
• Increases in pharmacist salaries with accompanying
mobility
• Limited expansion of services into medication
management, even if resources available, with
resultant health effects and costs
• Closure of rural pharmacies; loss of access to health
care in rural communities
• Increased difficulty in finding educational sites
• Some improvement in professional environment as
pharmacies needed to attract pharmacists
Asked whether the shortage would last long
enough for justify graduating more students.
• Yes, prescription numbers will continue to rise
• Capitation bolus - graduates of large classes in
1970s will retire in 10-15 years - we haven’t
seen the worst of the shortage yet
• Can’t count on surrounding states to produce
more
• Technology is not the sole answer
• We were not at the national average for
graduates (2/100,000 vs 3.1/100,000 average)
Expansion principles
• First class entered 2003
• One accreditation; same basic curriculum
• Distance education with 20 faculty at Duluth;
headed by Senior Associate Dean, Department
Head, some staff, student services;
• 60 additional students per class (165 vs 105)
• Rural emphasis, aligned with Medical School
• Use training sites all around the state for
experiential education
Class of 2016
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3.52 avg. GPA
90% B.S. degree
60% female
Age range: 20-57 Duluth class
38% non-Caucasian
8% international
66% MN resident
6% WI resident
Twin Cities class
Class of 2012
81% of New Practitioners
remain in MN
26%: Duluth and non-metro
MN
80% of students surveyed
By 2011 the capitation bolus had been
alleviated – better balance of ages
30.0
25.2
23.5
25.0
20.9
21.1
40-49
50-59
20.0
15.0
10.0
9.3
5.0
0.0
20-29
30-39
> 60
1800
1586
1600
1474
1400
1311
1326
40-49
50-59
1200
1000
800
600
585
400
200
0
20-29
30-39
> 60
Remaining Workforce Issues
• Tremendous opportunity for pharmacists to
maximize their expertise and education to provide
management of chronic illness as part of
collaborative team
• All pharmacists are not being fully utilized to the full
extent of their education.
• The public, patients and some health professionals
do not fully understand what a pharmacist can do.
• Medication management is not available for every
eligible patient because of health plan benefit
design.
Remaining Workforce Issues
• Likely decrease in dispensing jobs
• Will the shift in the role in patient care
occur fast enough to keep all pharmacists
employed?
• College will participate in workforce
professional development
• Will continue to monitor demand
Workforce Strategies & Recommendations
• Include a pharmacist as an integral component
of the medical/health home team.
• Include pharmacists as accountable providers
in Accountable Care Organizations;
compensate for role in improving health
outcomes.
• Utilize pharmacy technicians as a cost
effective way to distribute product.
Desired Outcomes
• Lowered total health care costs for
chronic illness.
• Better outcomes for patients.
• Improved health for chronically ill
• Prevention of illness (immunizations, etc.)
• Improved patient satisfaction.
• Other team members can spend their
time on what they do best.
• Help fill the primary care gap.
Curriculum revision for Fall 2013
• It is designed to produce pharmacists who are outstanding
clinicians with a strong scientific foundation, but who can
• participate in collaborative care settings,
• help lead change in the new health systems,
• contribute to achieving the “triple aim” (lower cost, better
health, improved patient experience) that is the goal of
US health care reform,
• and use technology effectively.
• New curriculum had a Fall 2013 start; will be rolled out over
four years.
Curriculum revision
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It begins with “Becoming a Pharmacist” and ends with “Being a
Pharmacist” aimed at developing professionalism and an understanding
of the context of healthcare and the patient experience early in the
curriculum and then focusing again on health systems and
professionalism as they experience it in the fourth year.
Integrated curriculum with active learning.
Competency domains:
1. patient-centered care
2. population health and vulnerable communities
3. health systems management
4. leadership and engagement
5. professional and interprofessional development
6. scientific inquiry and scholarly thinking
College of Pharmacy-run MTM Network
• Expansion of UPlan Medication Therapy Management
(MTM) Network:
– 2009: Added MTM benefit to UPlan per evidence of patient benefit.
– CoP:
• developed network of pharmacies & pharmacists across MN to serve U employees
• administers MTM benefit: recruiting & credentialing sites, CQI, marketing, reviews
– The State of MN engaged the network in June 2013 to provide
medication management to diabetics.
– Currently other customers would like to contract with UPlan network
for MTM and other pharmacy services.
– As contracts are implemented, we’ll spin off network management as
separate 501(c)(3) with collegiate oversight.