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Heath Care Outlook 2023: Lee Ann Stember, NCPDP

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Change is inevitable. This is a particularly exciting time to be in pharmacy, as we witnessed pharmacists’ swift support on the front lines of the COVID-19 pandemic, further demonstrating the need for and value of pharmacist-provided patient care services, pharmacists’ value to their communities, and a future for the expanded role of pharmacists. The pharmacy and broader health care industries are changing rapidly.

Lee Ann Stember

Mergers and acquisitions, consolidations and new market entrants trying to fix or profit from a fractured health care system are all faced with the same challenge: how to connect health care data. Standards make that possible. They are vital. NCPDP has developed standards for the pharmacy services industry for over 45 years, and our focus in the next several years is to support the connectivity of health care data and the expanding role of pharmacists as they increasingly move deeper into providing patient care services in the community and the home.

Standards are the framework for connectivity

When we talk about standards, some people don’t understand why standards matter. Most of NCPDP’s standards are ubiquitous, so it’s easy to take them for granted and instead focus on innovation as limited only to new technologies, drug therapies or care models. To be clear, we need more of that kind of innovation throughout the industry; and yes, standards are inherently innovative. They are continuously improved and provide the framework for connectivity to enable data to be captured and transmitted in real time to inform clinical decision making at the point of care. They make an interoperable, learning health care ecosystem possible. Plus, a key differentiator for NCPDP is that its standards are developed to conform to existing workflows, easing adoption and improving efficiencies. The evolution of NCPDP standards will use a top global programming language.

NCPDP’s work in advancing the next generation of its standards has already begun. Starting with one of the pharmacy industry’s core standards, NCPDP is migrating its Telecommunication Standard to the JavaScript Object Notation (JSON) format. JavaScript is a top global programming language. JSON is the ubiquitous data interchange format for Web services and application programming interfaces (APIs). Moving to the JSON format will enable NCPDP to use extensibility to add data elements to the standard, without requiring a change in the version of the standard. Plus, it facilitates easy access to the data via APIs. It completely modernizes and enhances the real-time pharmacy claims, eligibility, information reporting and pharmacy-generated prior authorization standard.

This work was a strategic goal for NCPDP the past two years, to speed up the standards development process and the speed at which we can deliver new or enhanced standards to the industry. It’s also inextricably linked to NCPDP’s strategic goals for innovation, leadership in standards development, and precision medicine, all of which seek to keep pace with industry advances and ensure the standards framework will continue to support the industry for decades to come.

Data collection and sharing standards

This decade we will see health care increasingly move toward the community and home settings where whole person health care can be supported locally by pharmacists and other health care professionals. Whole person health care takes into consideration a multitude of factors that contribute to health or disease. Social determinants of health (SDoH), nonmedical factors, like the conditions into which people are born and conditions under which they grow, live and work; political systems; economic policies and more, contribute to health outcomes. This data can be collected, standardized and shared by clinical pharmacists as they take on a greater role in patient care and care coordination that enables them to operate at the top of their licensure. SDoH contributes to health disparities and inequities. Addressing SDoH is an important step toward achieving health equity.

Let’s not forget the boomers. In this decade, 74 million baby boomers in the United States will have turned 65 or older. According to AARP, nearly 90% of adults over 65 want to age in place and continue to live independently in their homes for as long as possible. And it makes sense. Staying in one’s home and community enables individuals to maintain social connections which are positive contributors to better health and quality of life. Baby boomers are the second-largest living generation, so support in providing care at home, in assisted living, skilled nursing, rehabilitation, long-term care and through remote patient monitoring will need to grow in priority. Plus, they’re living longer than their previous cohort and are generally high utilizers of health care, with high rates of cholesterol, diabetes, hypertension and obesity — the management of which can all be supported by clinical pharmacists.

Strategic initiatives focus on elevating pharmacists’ roles

NCPDP has several strategic initiatives that support clinical pharmacists moving beyond dispensing and deeper into providing patient care services. The COVID-19 pandemic exposed critical gaps in care that are a natural fit for clinical pharmacists. It also revealed challenges with the current public health infrastructure. Last fall a pilot of NCPDP’s National Facilitator Model was launched, funded by the NCPDP Foundation. The pilot engages pharmacists to access, monitor and report COVID-19 vaccination series information to validate key capabilities of the model that can strengthen pandemic and epidemic preparedness and response, as well as support public health surveillance. Importantly, the model uses standards widely used throughout the industry to ensure interoperability and real-time access to data nationwide and within providers’ existing workflows. It also uses the Universal Patient Identifier (UPI), powered by Experian Health UIM and NCPDP Standards to assure that vaccination information is tied to the right individual to support public health.

Another strategic priority is to provide standards support for pharmacists’ participation in value-based arrangements (VBA). It’s an opportunity for pharmacists to fill gaps in care and provide comprehensive, collaborative care, supporting population health management, advising on medication therapies, coordinating care plans, identifying, monitoring and reporting SDoH, and participating in outcomes reporting. NCPDP conducted an analysis of its Telecommunication and SCRIPT Standards, and the NCPDP/HL7 eCare Plan to identify existing data elements useful to collaboration and clinical interventions by pharmacists and other providers who could be part of a value-based contract. The analysis showed that we currently have nearly 60% of needed data elements within these standards to support VBAs. NCPDP also convened a stakeholder action group to uncover existing challenges. Among them are interoperability hurdles between pharmacy management systems and EHRs; access to real-time, bidirectional data; support for activities that are patient-facing, payer-facing, or required for contracting or reporting; and reimbursement for pharmacist-provided clinical services. Notably, participants cited the need for pharmacists’ scope of practice to evolve, with specific recognition as a provider.

NCPDP has other strategic initiatives under way to provide standards support for digital health, precision medicine and pharmacogenomics. In many ways these fields are all advancing rapidly. At the same time, there is much to be done to bring the data into clinical practice in a coherent and meaningful way. Artificial intelligence will be important in turning vast volumes of all data into actionable insights, not just in these fields but across health care. In March, NCPDP will host a stakeholder action group on precision medicine to further define goals and next steps.

Join us in doing the good work of NCPDP

Change is good. It challenges our agility, creativity and resilience. Our members, staff, executive management team, and board of trustees are all engaged in supporting this transformation that — over time — will prove to be a monumental change in health care. Join us. Participation in NCPDP task groups is open to members and nonmembers. Join a task group — or become a member — and lend your expertise to our collaborative, consensus-based, problem solving forums.

Our vision is to lead the industry in health care standards and solutions for the common good. Clinical pharmacists have an important and underutilized role in improving health care. They are trusted advisors, uniquely positioned in the heart of communities, and professionally trained medication experts. NCPDP will continue to actively examine its standards to help ensure they evolve to provide the pathways that support pharmacists’ expanding role in patient care and digital health and to collect and share SDoH, relevant multi-omics data and other patient data amongst the care team to improve patient care, care coordination, and outcomes — and support the future of health care.

Lee Ann Stember is president and chief executive officer of NCPDP.


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