Cardinal Health Specialty Solutions’ Clinical Pathways program sharply reduces the cost of treatment

BY Michael Johnsen

DUBLIN, Ohio — A series of new clinical studies released Tuesday found that Cardinal Health Specialty Solutions’ Clinical Pathways program reduces the cost of cancer treatment, improves clinical care and shows promise for guiding treatment of other high-cost, complex diseases beyond cancer.

The five studies will be featured in early June at two prominent medical meetings, the American Society of Clinical Oncology annual meeting in Chicago and the International Society for Pharmacoeconomics and Outcomes Research annual meeting in Montréal.

Several of the studies found that the ability of the company’s Clinical Pathways to significantly reduce cancer treatment costs while improving clinical care — first reported at ASCO’s annual meeting last year — could in fact be replicated, when implemented by other payers and different sets of physicians and patients, in varying geographic areas.

One of the 2014 studies reported an 18.3% decrease in chemotherapy costs when physicians participated in the Clinical Pathways program. An earlier study, released by the company just last year, found a 15% decline. In both studies, patient outcomes were similar or better than those of a control group. For example, participating payers report that that their members experience shorter hospital stays and fewer emergency room visits, which reduced total treatment costs.

Bruce Feinberg, chief medical officer and VP Cardinal Health Specialty Solutions, said the new studies show the company’s Clinical Pathways are delivering the “trifecta of improved outcomes — reduced costs for payers, appropriate, aligned physician reimbursement and, most importantly, better quality of care for patients.” 

Cardinal Health Specialty Solutions’ Clinical Pathways are physician-led programs that establish best practice treatment protocols for specific disease states. Studies of the company’s Clinical Pathways programs have found that physician reimbursement can remain neutral or actually increase — while total treatment costs fall — when its Clinical Pathways are effectively implemented.

Feinberg reported that working with payers to develop incentives to encourage physicians to participate in the programs – and to develop new payment models that reimburse physicians for delivering cognitive services and quality care, are keys to the success of the program.

“It’s a win-win-win paradigm,” Feinberg said. “Every stakeholder involved in the healthcare process can benefit.”

Another study found that the company’s Clinical Pathways program reduced treatment costs while improving quality of care for rheumatoid arthritis patients. CareFirst BlueCross BlueShield reported substantial cost savings, while obtaining clinically equivalent results, by having physicians establish an evidence-based algorithm to guide drug treatments, and by incorporating that algorithm into Clinical Pathways.

In Cardinal Health Specialty Solutions’ Clinical Pathways model, local, physician-led teams establish evidence-based treatment protocols for their practices and networks. Participation is voluntary, but physicians are encouraged and usually incented to follow the pathways, which are monitored and frequently updated to reflect the most recent, up-to-date clinical evidence.

The goal is to make the treatment of complex, high-cost diseases as cost effective as possible by empowering physicians to consistently follow the best clinical evidence, and by reducing unnecessary or less effective treatments, thereby lowering total costs and improving clinical outcomes.

“As medicine grows more targeted, more precise and often times, more costly, all players in the healthcare system are increasingly focused on ensuring the right patients receive the best, most targeted and clinically proven medicine, at the right time,” stated Meghan FitzGerald, president, Cardinal Health Specialty Solutions. “This new body of research proves that our innovative approach to encouraging collaboration among multiple stakeholders can achieve those goals – while reducing unnecessary costs and ensuring physicians are fairly reimbursed for delivering the best possible care to patients.”




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As pharmacy practice evolves, so does role of the preceptor

BY Jim Frederick

Nowhere is the value of solid preparation and training more evident than in the fast-evolving world of health care and community pharmacy.

The rapid expansion of pharmacy-based clinical care programs and patient engagement efforts has elevated the need for pharmacists to mentor student pharmacists as preceptors. And it’s made student participation in pharmacy practice rotations and residencies a critical part of the professional education process, as those students prepare for a career in a reforming health system in desperate need of expanded front-line patient care services from pharmacists.

Pharmacy operators that participate in preceptor and residency programs are not only helping the next generation of pharmacists prepare for the more demanding and complex model of pharmacy practice necessitated by the evolving healthcare system. They’re also helping to advance the profession of pharmacy as a whole — and uncorking a new and vital source of ideas and energy within their own practice sites.

Student internships and precepting bring “high value for both the pharmacy student and the pharmacy practice site,” said Clark Kebodeaux, assistant professor of pharmacy practice at St. Louis College of Pharmacy and a shared-faculty pharmacist and preceptor at a Walgreens pharmacy and wellness center in St. Louis. “We work hard as pharmacists to try to make the experience as valuable for the students as possible.”

“I think students are heavily influenced by their practice settings” during their rotations, Kebodeaux added. “We’re trying to transform the practice of community pharmacy at Walgreens, and our students play a part in that. As a preceptor, I’m trying to open students to the innovative practices and services that Walgreens is doing for patients. It’s definitely one of the more rewarding parts of my job.”

Kebodeaux said it’s important for a pharmacy preceptor or manager to evaluate the strengths and weaknesses of his or her particular pharmacy to prepare for student rotations and tailor a successful mentoring experience for them. At Walgreens, for instance, “we administer a lot of immunizations,” he said, as well as have a private consultation room and an experienced pharmacy staff that can set goals for students and guide them in community pharmacy practice.

One key to a successful preceptor program, Kebodeaux added, is “making sure you’re engaging both the front end and back end of store … to interact with the business side of the store, using all the folks you have.” And behind the counter, he said, “technicians can play a big role” in areas like managing pharmacy workflow and helping interns get oriented to the medication use process.

“When you’re coming up with activities for your student, consider the needs and workflow of your own practice site. For instance, if you’re in the middle of flu season, that isn’t necessarily the time to start a new cholesterol testing service or have the student do a variety of diabetes things. That might be better for American Diabetes Month.” In addition, Kebodeaux said, “it doesn’t always have to be your most tenured pharmacist who is the preceptor; it might be more effective to give it to the one who wants to do it the most.”

Rewards for students and mentors
The benefits these efforts bring to up-and-coming pharmacy interns are clear. “Residencies provide opportunities that exist nowhere else, and introduce residents to other healthcare professionals,” said Stephen Vodhanel, distance education specialist at Loma Linda University School of Pharmacy. “One of the best aspects of a residency is that it allows you to expand your knowledge base in a multitude of areas, while still having the safety net and built-in support system of preceptors and professors.”

CVS Caremark defines preceptors as “pharmacists who, traditionally, have the responsibility of evaluating and documenting that the intern completes a set number of hours required for graduation.” However, the company noted in a description of its preceptor training program, “in today’s ever-changing world, we believe the role of the preceptor is so much more than that.” Given the company’s stated goal of improving “the quality of human life,” preceptors at the chain’s practice sites “serve as a teacher, leader and role model … to provide an enriching, meaningful experience for interns.”
Among best-practice preceptor duties at CVS, said the company, is to serve as “co-owner of the undergraduate and graduate intern training program with the pharmacy supervisor,” to “actively promote and support CVS Caremark, … [to] coach and counsel interns when necessary and reward for a job well-done,” and “complete a yearly performance review along with an individual development plan with interns.”

Said CVS pharmacy manager and preceptor Greg Harrington: “We all owe it to our profession to take on the responsibility of precepting, as those did before us. I was fortunate to work with great preceptors, some whom had been pharmacists for 25 and 30 years, and this made a huge impact on me. And I want to make sure I have the opportunity to influence other students.”

“As a preceptor, I get a chance to use my experience in making students become good pharmacists in the same manner as those preceptors who helped me,” Harrington said in a report published by Loma Linda University School of Pharmacy. What’s more, he said, precepting also is a valuable experience for any corporate or professional entity. “Through precepting, we get a real close look at a student’s skills and knowledge, but also at how they will handle themselves in an often stressful situation that demands good people skills. Students need to understand that the pharmacy profession truly is a small family and that every rotation is a potential audition for a job. Take each rotation seriously and work professionally, as you may meet these same people later in your career, or, and this is common, someone in an interview will know that person whom you once worked under.”

Ryan Koca, clinical informatics pharmacist at Tenet Healthcare, called his residency experience “undoubtedly the best decision I could have made after completion of my doctor of pharmacy program at the University of Illinois at Chicago. There is a whole world of opportunities out there in the profession of pharmacy, and a residency program is the key to unlocking many doors.” 

Training programs multiply
The growing importance of preceptors and pharmacy internships and residencies hasn’t been lost on the profession. Both pharmacy professional organizations and colleges of pharmacy have developed a growing list of resources to help guide would-be mentors and improve the residency experience for students as they prepare for a professional career in the fast-changing pharmacy practice setting.

One example comes from Drake University and the University of Iowa Colleges of Pharmacy, which have joined forces to establish the Collaborative Education Institute, or CEI. The institute provides a web-based forum for delivering ongoing education for preceptors, including a rotating series of on-demand teaching webinars on preceptor development.

On the professional organization front, the American Pharmacists Association, in partnership with the National Association of Chain Drug Stores, has developed an educational tool called the Community Pharmacist Preceptor Education Program designed for pharmacists who would mentor students within the community pharmacy setting.

“The education of student pharmacists is shifting to meet the envisioned and evolving role of the pharmacy profession,” APhA reported. “As practicing pharmacists have assumed greater roles in patient care, the emphasis on experiential education and reliance on preceptors in pharmacy school programs have grown.”

Indeed, says the pharmacy group in an introduction to the program, “introductory and advanced pharmacy practice experiences [or IPPEs and APPEs, also known as ‘rotations,’] are now critical elements of future pharmacists’ education and training. These experiences assist student pharmacists in integrating and applying knowledge from the classroom and developing critical thinking skills.

“Ultimately, these experiences promote a lifetime of learning,” APhA added.

Beyond the immediate need for the next generation of pharmacists to gain a higher level of broad-based and hands-on practice experience in patient interaction, disease management, collaborative care and clinical services like immunizations and health screenings, the increased focus on residencies and precepting also is being driven by rising standards for pharmacy education and training. The Accreditation Council for Pharmacy Education, or ACPE, raised the bar for schools of pharmacy in 2007 with the release of new educational standards and guidelines that require student pharmacists to participate in a range of IPPEs and APPEs “designed to help them apply classroom knowledge to the practice of pharmacy.”

To meet these new requirements, APhA said, “practicing pharmacists are being called on to play a greater role in the development of future pharmacists by acting as preceptors.”

The view from the campus
Speaking for the pharmacy education community, educator Javad Tafreshi noted that pharmacy practice residencies where students have access to the guidance of preceptors are becoming an increasingly important part of a pharmacy degree program. “Recent trends in the pharmacy profession have seen more demands for pharmacists with additional training and experience over and above the PharmD degree,” said Tafreshi, professor and chair of the Department of Pharmacy Practice at Loma Linda. “The profession has changed substantially in the last decade or so. Years ago, the PharmD was recommended, but not required; now it is a basic requirement. Today, we are seeing more and more positions where both general and specialty residencies are required, along with the PharmD degree.”

At the University of North Carolina’s Eshelman School of Pharmacy, pharmacy preceptors “play a central role in the Experiential Education Program” and “serve as mentors and role models who demonstrate high standards of professionalism” by showing students “how to apply knowledge learned in the classroom to daily practice,” said Kim Leadon, director of UNC-Eshelman’s Office of Experiential Education. “In pharmacy education, the experiential component is designed to provide in-depth exposure to and active participation in all pharmacy practice settings.”

Typical of university-affiliated preceptor and residency programs is that offered by Nova Southeastern University College of Pharmacy in south Florida. “Introductory and advanced practice experiences for the student” allow pharmacists in training “to be introduced to community, hospital and expanded clinical practices,” noted the school in a report on its preceptor program.

“To accomplish these experiences for our students, we have more than 800 pharmacist preceptors in various practice settings,” Nova reported. “Second-year student pharmacists are assigned to a community pharmacy with a community pharmacy preceptor. The ‘classroom’ for these students is located in a community pharmacy for half a day a week during the P2 year.”

In that setting, said the report, “students are exposed to the role and responsibilities of the professionally oriented community pharmacist and the importance of effective communication between pharmacist, patients and other healthcare providers. On-site experience provides basic knowledge of the drug distribution process in a community pharmacy. Legal, ethical and practice issues in the pharmacy also are discussed with their preceptors.”

Third-year students at Nova gain guidance from a preceptor in a hospital pharmacy, where “activities include prescription preparation, using a unit dose system, use of references and inventory management.” Fourth-year students rotate each month to an “Advanced Pharmacy Practice site,” according to NSU, where they work with a preceptor in “various pharmacy practices each month for a total of nine months at 160 hours per month throughout the P4 year.”

Kebodeaux said the benefits of offering rotation sites and preceptor mentoring at Walgreens far outweigh the costs and time involved. “Precepting students pharmacists can be a rewarding and engaging experience, and can really push the profession forward,” he said. “I’d encourage [pharmacy operators] to keep trying this.”

What’s more, he said, students often end up teaching the preceptors and the site staff, as well. “One of the things I like about students is they’ll teach me things,” he said. “It’s a win-win-win for everybody.”


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PepsiCo, PepsiCo Foundation combine efforts to support flood relief

BY Ryan Chavis

PURCHASE, N.Y. — PepsiCo and the PepsiCo Foundation on Tuesday announced a donation of $300,000 to support relief efforts in Serbia and Bosnia and Herzegovina after flooding devastated the areas. PepsiCo also will donate 1.5 tons of product to the cause.

The resources will be allocated to the American Red Cross International Response Fund and the World Food Programme. The Foundation will liaise with agency partners to assess deployment of the relief and to gauge potential needs that may arise in the future.

World Food Programme, a United Nations agency, is a humanitarian organization which fights hunger and delivers food to communities in need. On average, WFP feeds more than 90 million people in more than 80 countries. The PepsiCo Foundation has a history of working with such organizations as FP, the Red Cross and others to bring relief to communities that have been ravaged by natural disasters.


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