Meeting Resources

 Attendance

Guests:

Guy from … pr for health centers in S. Carolina

Greg Williams

E.izaeth Linderbarum

Chief.. parhamcy officer truehealth

chief pharmy officer… central??

Sarah Price

 Agenda and Notes

2023 Subcommittee on Pharmacy Policy and Operations

Friday, August 25, 2022

10:30 am – 12:30 pm

Chair:              Jennifer Kreidler- Moss Pharm D

Co-Chairs:       Nicole Thibeau and Sue Veer

Staff:                Kathy McNamara and Vacheria Keys

Venue:            Balboa C, Manchester Hyatt, San Diego, CA

Notetaker:      Andrea Price

Detailed Agenda for Internal Use Only AS OF 8-19-23

Purpose

1. To engage thought leaders and subcommittee members to inform the Pharmacy Strategy for health centers moving forward

2. Create a forum to give a voice on current concerns, environment, and inform NACHC on Pharmacy Policy, Business Practices, Workforce etc.

3. To advise and make recommendations for legislation and advocacy

4. Identify Best Practices

Logistics

·         Room Layout: Board meeting with chairs on the periphery  

·         Set up: Emily and Liz name tents, agendas, chairs at the head, flipcharts.

·         AV/Room Flow: no AV

Prework:

·         Starbuck Drink request  Andrea Price

Supply Group

Items

Quantity

Handouts

Agendas

Committee Application

20

Office Products

Name Tents in plastic covers (20)

1 Flip charts w/ stand

Room set-up

Hollow Square or Boardroom for 20 plus 20 chairs around the perimeter

• 6' skirted table inside room for name tents

• 6' skirted table inside room for materials

• 6' skirted table inside room for notetaker near an outlet

Agenda Item

Lead

Amount of

Time

Start Time

Handout

Notes

Logistics

Emily

30 minutes

10:00 am

Agendas

Name tents

o   Room set-up  Board Room

o   No mic or AV

o   Name Tents

o   Chairs and Co-chairs at head

o   Sign in roster with Chair

o   Note taker hook-up to computer

o   Only agendas at the meeting

o   Chairs around the perimeter for observers

Coffee Run

Andrea

NA

10:00am

1. Welcome

·         Chair introductions

·         Welcome to new and returning members

Jennifer

5 minutes

10:30 am

Jennifer:

·         Call the meeting to order

·         Welcome New Members

·         Introduce co - chairs

o   Sue

o   Nicole

1. Call To Order

·         Review and approve agenda

·         Committee Charge

·         Review Handouts

Jennifer

2 minutes

10:35 am

Agenda

Jennifer

Agenda

1. Call to Order

• Welcome

• Review Board Report from March 6, 2023

• Approve Agenda

2. Conversation with Dr. Rhee

Dr. Rhee

Coopatition - Pharmcies like CVS are now doing primary care, which is a good thing, but they have certain interests in mind.

Pharmacists should be reimbursed as provides.

Vacheria - it would be a state by state approach for medicaid but for medicare, too.

There are new roles for Chief PHarmacy Officer - supporting that growth ; the CEO listens to NACHC,

Practice Acts - when there is something coming from CMS, state people may take more note.

Terminology - Ambulatory care pharmacists - not clinical, they all are trained clinically.

In many CHCs the registered nurses can adjust standing orders adn get reimbursed - because there are not enough pharmacists…

Would like to se NACHC push - CMS should carve out services for opioid crisis. The X is going away and that will force the services downwards, to be done by nurses, others, who cannot get reimbursed for it.

To retail primary care - you have to be a good partner - push for everythingn that we need.

National Community Pharmacy Association has been a partner, but National Pharmacy Association - Dr. Rhee can help make connections there.

Three bundles - how to prioritize, which states and which services?

infectious disease strep, flu, covid test and treat

chronic disease management -Diabetes, Hypertension - Vacheria’s first priorty

PHQ2s or DAD7s PrEP - public health - where there are disparities CHCs are trusted. Are there more policies relevant to our populations that we should push to reimburse.

Payors react to three forces:

• Medicare

• Medicaid states

• Commercial employers

Health center employees and their families are about 1 million people. We woudl be a coalition of … like a NACHC health plan as a buying group.

Around 50% of chcs have a pharmacist.

Vacheria - We should have a track for pharmacy at FOM/IT. New CEOs and new CFOs go to that historically, this would be training for that new person. Why FOM/IT? Because financing and operations, might help to bring the front of the house and back of the house together.

Note - Jennifer - Board won’t send ppl to DC - cost is too high.

Suggestion - do a survey on the priorities for Dr. Rhee’s 3 bundles. Kathy there are many ways to do this other than sureys, but we can collect data, questions on registration forms, have PCAs include on their surveys.

where are you on the org chart

• what is your role

• what are your main concerns

• Who is providing what types of ambulatory services?

Even if CHC has no pharmacy, they will have someone doing “pharmacy activities” …

Broader goal: how can we act so that two years from now, there is a pharmacy track to a NACHC conference.

Kathy -embed a training at every conference with the same curriculum the messaging is the same but players in the states are different.

3. Call for approval of the Minutes

o   Motion to Accept:  Mary Blankson

o   Second Motion to Accept: Hannah Rowell

o   Minutes Approved: Unanimous

4. Review the Committee Charge

·         Distribute sign in sheet

Committee

·         Review Handouts

·         Note recommendations to the BOARD March  2033.

NACHC explore federal and state regulatory and legislative strategies to advance pharmacists as providers for reimbursement’.

1. In addition to the newly outlined federal 340B strategy, NACHC track, monitor, and help CHCs strategize against 340B Medicaid carve outs at the state level.

Charge:

Focus on patient centric emerging models of pharmacy policy and operations that

impact patient access and improve health outcomes, business principles, scale and sustainability of Pharmacy Programs.

Advises NACHC on legislative and regulatory policies, funding, reimbursement, and pharmacy policy and operations.

5. Chairs’ Report

Jennifer/Sue

10

minutes

10:40 am

Jennifer/Sue/Nicole

Jennifer:  Potential Reflections:

ü  New CEO  Dr. Khu Rhee

ü  Active Board reviewing by-laws

ü  340 B ASAP

ü  Personal thoughts

Sue:

ü  340 B ASAP

ü  340 B Meeting

ü  Personal Reflections

Nicole:

ü  PBMS

ü  Immunizations health center role/cost (Health department. Ex. Monkeypox)

ü  Personal Reflections

1. Introductions

Sue

15 minutes

10:50  am

Participant Intro: 2 minutes each

·         Name, org, role

·         Highlight what are the key issues in your state? Facilitators and barriers.

1. Reports

Jennifer

10 minutes

11:05 am

Reports:

·         LGBT Taskforce (Anthony Fortenberry)

·         Adult Immunizations (Sarah Price)

1. Federal and State Policy Report

Vacheria

20 minutes

11:15 am

Key Policy Topics:

·         Strategies around pharmacists, licensing, and workforce

·         Unwinding of PHE implications

·         340 B ASAP Update

·         340 B Workgroup update

1. Open Discussion.

Jennifer

30

minutes

11:30 am

Jennifer

1. UDS Classification of Pharmacists (clinical vs retail)  FYI No updates from HRSA BPHC.

1. PHE Unwinding - Status and Implications

1. PBMs update

1. Shortages of Pharmacists, technicians

1. Drug shortages

1. Adult Immunizations supply chain and access, reimbursement.

1. Decreased revenue managed care fee for service: new models needed

1. Recommendations to the Board

Sue

15 minutes

12 noon

Board Report see previous recommendations

Sue

·         Roberts Rules of Order, only members can inform and vote.

1. Meeting Review

·         Report to NACHC Board

6. Federal and State Policy Update (Vacheria)

7. Reports

LGBTQ Health Task Force Gender Affirming Care (Anthony Fortenberry)

• Providers leaving

• Providers feeling unsafe

• Organizations that no longer provide gender affirming care drive patients to FQHCs

Adult Immunizations (Sarah Price)

• Adult Immunizations Speaking Notes—Pharmacy Sub-Committee 

Spent the last 5 years exploring adult immunizations in the areas of:  people, processes, technology, and policy;  Over 80 health centers in 25 states and 5 networks 

People:   

• Health care workers---Standards for Immunization Practice  

• Strike Teams 

• Vaccine Ambassadors--CHWs 

Role of Pharmacists (pharmacy practices and policies) 

Process 

Standards for Immunization Practice---Assess, Recommend, Administer/Refer, Document 

Example:  For 44 health centers, asked about which vaccines are stocked and which are routinely referred out for: 

• The vaccines most commonly administered on-site are: Flu, Tdap, Pneumo, Hep A, Hep B, Men, and  

• The vaccines that are not administered on-site, for between 3 and 7 health centers, are: live flu, MMR, Varicella, Zoster, HPV, Men B, and Hib; 1 health center does not administer Zoster on-site and 1 health center does not administer Hep A on-site.  

IIS systems 

Building the Business Case (there is none) 

COVID-19 vaccine access (waxing and waning) 

Technology 

Data pulls—challenges for even baseline data 

Big data 

Small data 

 Lack of infrastructure in place to capture (free texting) for both admin or declination 

IIS—very few bidirectional 

Policy with a lens of equity 

Immunizers—i.e. pharmacy techs 

Medicaid/Medicare Reimbursement 

NEW!  COVID-19 vaccine funding and access

Mary Blankson - issue of HRSA requirements for everyone to be offered same ….

Anthony Fortenberry - We want to be able to offer vaccines if they were in the office… not to have to refer them out.

8. Open Discussion

9. Recommendations to the Board

1. NACHC prioritizes federal and state regulatory and legislative strategies to advance pharmacists as providers for reimbursement.

2. NACHC develop a national plan to elevate ambulatory care pharmacists with an integrated education, training model with a learning community. The Model will include ancillary pharmacy services in beyond 340 B to be completed in 2024.

3. Request clarification from HRSA regarding equity in provision of adult vaccinations via different pathways so health centers to participate in vaccine programs for the uninsured.

10. Next Meeting

Policy and Issues Forum 2024

Marriott Marquis, Washington DC, February 12-

15

Committee Meetings

February 10-

Jennifer

5 minutes

12:15

Jennifer

·         Personal Thoughts moving forward.

·         Highlight last meeting of a two- year cycle.  Time to apply for Committees.  See handouts.

·         NACHC staff will be working with the chair on the minutes and prepare the Board Report.

·         Chairs please note there will be a meeting with Mike Holmes and Rachel to discuss recommendations before the Board Meeting. Saturday August 26 from 1-2pm   Regatta AB Room.

·         Jennifer will report out to the Clinical Committee

·         Look forward to seeing you in Washington DC at the next meeting.  Note it is early in February.

·         Ask for feedback how to improve the meeting?

10.    Adjourn

Jennifer

12:30 pm

 11

11. Adjourn