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Robert Rangel, PharmD, PhC, BCPSMedical Director – Pharmacist Clinician and Anticoagulation ServicesPresbyterian Medical Group

• The planner and presenter of this presentation disclose no conflicts of interest including no relevant financial relationships with any commercial interests.

• Research is subject to different interpretation.

• The speaker confirms the research is educational in nature and the presentation abides by the non-commercial guidelines.

• I am not an expert in the area of service development.

• I am not an expert in the area of leadership.

• What you are about to hear are mostly my opinions and my own experiences.

• You may disagree with me.

• Describe the advantages of an integrated healthcare system as they pertain to the development of pharmacy and other services.

• Implement strategies to better understand and become aligned with organizational goals.

• Develop a better understanding of the social aspects of navigating management, leadership, and teams.

• Obtain new strategies to get people to listen to your ideas using influence not authority.

• Describe the advantages of an integrated healthcare system as they pertain to pharmacy technician services.

• Implement strategies to better understand and become aligned with pharmacy departmental goals.

• Develop a better understanding of the social aspects of navigating management, leadership, and pharmacist teams.

• Obtain new strategies to get pharmacy leadership and others to listen to your ideas using influence not authority.

“Clinical leaders are the linchpin of health care organizations, bridging the gap between C-suite executives and frontline clinicians, and bolstering the patient voice. As transformation in the health care industry deepens, clinical leaders will be the innovators of design, the assessors of cost efficiencies, and the promotors of more patient-centered care.”

The Critical Role of Clinical Leaders: Transforming Care Today and Tomorrow.NEJM Catalyst

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• Budgets• Finance• Human Resources• Staffing• Hiring • Operations• Scorecards• Payor contracts

¨ Value-based payment systems

¨ Too many other things to list

• First job out of residency was at Presbyterian Coumadin Clinic.

• Started expanding my services at the clinic level.

• Opportunity to participate on a quality committee.

• I volunteered to rewrite our job profiles to require PhC license.

• Became more interested in making changes to PhC services.

• I was approached about taking over the supervisor role for primary care PhCs and Coumadin nurses.

• Changed job profile from Supervisor to Director.

• Elected as Advanced Practice Clinician voting member on PMG Executive Council.

Good To Great – Why some companies make the leap… and others don’t.Jim Collins; 2001.

• Presbyterian Medical Group (PMG)

• Presbyterian Hospitals

• Presbyterian Health Plan (PHP)• Capitated plans• Per member per month payment• We own all the financial risk

• Fee-for-service versus value-based care

Scorecards – Medical group

• Clinical outcomes• D3 bundle• A1c• Blood pressure • Lipids

• Access• Demand for primary care providers • Provider shortage• Commercial health plan business

demands more services

• Patient and provider satisfaction

Stars ratings, HEDIS – Health plan

• Clinical outcomes• Diabetes • Blood pressure • Microvascular risk screening• Medication adherence

• Access• Growth of health plan membership• Keeping members in-network is less

costly• Marketing medical group services

increases commercial business

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• 24 PhCs in the Pres system• See approximately 12-16 patients per day• 30 minute visit slots

• Practice settings• Primary care• Heart failure• Neurology• Endocrinology• Complete care (High risk, high cost senior patients)• Gastroenterology• Infusion Center• Inpatient Infectious Disease• More to come!!

• 26 Anticoagulation RNs under PhC team leadership• See approximately 25-30 patients per day• Primary care and cardiology clinics

• Medical Director - PhC and Anticoagulation Services• Assistant Medical Director – PhC services• Anticoagulation RN Supervisor

• Finances and reporting• PMG finances PhC services• PhC leadership reports directly to Physician leadership• Dotted line reporting to pharmacy

• Medical group owned versus pharmacy owned• Buy-in and accountability matter• Financing of positions looks very different

• Coumadin clinics

• PhC license requirement

• PhCs moved from pharmacy to medical group• Financial accountability• Direct reporting restructured

• Observation of PMG Exec Council meeting• My new boss was chair of PMG Exec Council

• Negotiated with PHP • Copays removed from PhC visits• MTM coding for financial tracking

• Requested to present PhC services and volumes to PMG Executive Council

• CME funding

• Credentialing and privileging

• Advanced Practice Clinician representative on PMG Exec Council

• Advanced Practice Clinician designation formalized

• APC Medical Director

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