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Rosana Oliveira, PharmD., BCPS, BCPP

The 2016 CPNP Annual Meeting in Colorado Springs began with an exciting Pre-Meeting Workshop on psychiatric pharmacist-driven comprehensive medication management (CMM). Dr. Steven Chen, PharmD, FASHP, FCSHP, FNAP, of the University of Southern California School of Pharmacy led the audience in an interactive discussion about “The How-Tos of Developing Collaborations to Improve Care, Access, and Reimbursement.” By learning from CMM experts within the psychiatric pharmacy field about best practices, participants left the Pre-Meeting well-prepared to take action in advancing their clinical pharmacy services by knowing how to overcome barriers and select outcomes that are important to engage financial partners. Additionally, the development of this session resulted in even more robust resources being shared on the CPNP website from which all members can benefit.

With a significant shortage of mental health professionals across the United States, psychiatric pharmacists are in an optimal position to improve patient care by integrating CMM services into the existing workflow of an organization.1,2 To increase the likelihood of success of such a program, Dr. Chen offered a stepwise process for CMM implementation:

  1. Secure support from senior medical leadership
  2. Align the CMM program with financial incentives of the organization
  3. Identify high-risk populations who could benefit and consider who could pay
  4. Identify staffing options and reimbursement
  5. Develop CMM collaborative practice agreements that integrate the program into existing workflow
  6. Ensure that reliable data is available for program evaluation
  7. Maximize efficiency and productivity

A CMM program built on this foundation will help ensure that both patients and the healthcare organization will benefit from the value-based and innovative services that psychiatric pharmacists can provide. Dr. Carla Cobb, PharmD, BCPP one of CPNP’s own leading experts in CMM, discussed her practice at RiverStone Health in Billings, Montana. Medication management for patients with mental illnesses is offered in an integrated health clinic in which clinical pharmacist practitioners with collaborative practice agreements provide CMM services to patients. These services have resulted in costs savings of nearly $100,000 and a return on investment of 2:8:1.3-4 Dr. Chen also shared his work in which CMM is provided to high risk patients (e.g. high cost, frequent/recent acute care utilizers) within the AltaMed network of community clinics and health services. His program incorporates trained clinical pharmacy technicians which allow pharmacists to spend more time performing activities at the top of their scope of practice. This model has resulted in improvement in a number of outcomes including HbA1c levels, blood pressure control, hospital readmissions, identification of medication-related problems, and patient and physician satisfaction.5

A number of other practitioners from a variety of clinical settings also provided short presentations of best practices nationwide. Dr. Lisa Goldstone of The University of Arizona College of Pharmacy, shared how she used a step-wise approach (see Figure 1 below) to develop patient medication education groups, a value-based service that has resulted in decreased hospital readmissions related to medication nonadherence.6 Also featured was Dr. Shelia Botts of Kaiser Permanente Colorado. The Kaiser Permanente National Program has been a top ranked health care plan with positive outcomes from a number of their programs including anticoagulation and anemia, cardiac risk, hypertension, osteoporosis, skilled nursing facility transitions, medication therapy management/comprehensive medication management, metabolic monitoring, and quality and safety/high risk medications.7-13

Developing a “hot spotting” program was described by Dr. Dri Wang. “Hot spotting” is targeting areas in which your institution may be wasting money or resources and identifying the population that could potentially result in the most cost savings through the provision of pharmacy services. State-wide or national quality measures must then be selected as outcome measures to demonstrate the value of your service. Dr. Seth Gomez talked about conducting a psychiatric medication management landscape assessment and how this can be used to align outcomes with quality measures to identify gaps in quality of care. Provider status is still a hot topic for pharmacists in today’s changing healthcare world and Dr. Kelly Gable discussed how to secure and leverage provider status for pharmacists by sharing her personal experiences in Missouri. After many years of valuable networking with legislators, other state leaders (e.g. director of Medicaid), and the state board of pharmacy, she became the first pharmacist to be recognized by the Missouri Department of Mental Health as a psychiatric provider and prescriber. She urged the audience to pursue board certification, become familiar with state laws and collaborative practice agreements, and to get involved in local and national initiatives to expand our roles as providers.

Figure 1: Developing a Value-Based Service

The session concluded with guidance from Dr. Chen on recommended steps to take to develop a CMM value proposition. These steps included characterizing the population to be served, naming the high value outcomes to be achieved, describing the program that will deliver the results, identifying the cost structure that will drive the program, naming the price requested for the outcome and outlining the program that will be used to monitor the program and track commitments. Each attendee was given time to create his or her own value proposition and to share it with other participants and the speakers. This interactive session left participants energized and excited to return to their own practice sites and begin to develop value-based services to improve patient outcomes as a member of the healthcare team. Participants will also be given the opportunity to participate in up to two post-meeting webinars led by Drs. Chen and Cobb.

Take Home Points

  • Implementation of CMM and other services should follow a step-wise process
  • CMM results in improved patient outcomes and cost-savings
  • A value proposition is critical to develop for use in discussion with senior leaders and payers.


  1. Shortage Definition: Health Professional Shortage Areas & Medically Underserved Areas/Populations. U.S. Department of Health and Human Services. Accessed on May 18, 2016. Available at: .
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  3. Rubio-Valera M, Chen TF, O'Reilly CL. New roles for pharmacists in community mental health care: a narrative review. Int J Environ Res Public Health. 2014;11(10):10967-90. DOI: 10.3390/ijerph111010967 . PubMed PMID: 25337943 ; PubMed Central PMCID: PMC4211017 .
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  5. Butler A, Dehner M, Gates RJ. California Department of Public Health. Comprehensive Medication Management Programs: Descriptions, Impacts, and Status in Southern California, 2015. Accessed on May 24, 2016. Available at: .
  6. Arterbury A, Bushway A, Goldstone LW. Effect of a pharmacist-led medication education group on hospital readmissions due to medication non-adherence for patients with previous inpatient psychiatric admissions. J Pharm Pract. 2014; 27:279.
  7. Witt DM, Sadler MA, Shanahan RL, Mazzoli G, Tillman DJ. Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest. 2005;127(5):1515-22. DOI: 10.1378/chest.127.5.1515 . PubMed PMID: 15888822 .
  8. Witt DM, Humphries TL. A Retrospective Evaluation of the Management of Excessive Anticoagulation in an Established Clinical Pharmacy Anticoagulation Service Compared to Traditional Care. J Thrombosis Thrombolysis. 2003;15(2):113- 118. DOI: 10.1023/B:THRO.0000003325.62542.43 .
  9. Merenich JA, Olson KL, Delate T, Rasmussen J, Helling DK, Ward DG. Mortality reduction benefits of a comprehensive cardiac care program for patients with occlusive coronary artery disease. Pharmacotherapy. 2007;27(10):1370-8. DOI: 10.1592/phco.27.10.1370 . PubMed PMID: 17896892 .
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  11. Pike C, Birnbaum HG, Schiller M, Sharma H, Burge R, Edgell ET. Direct and indirect costs of non-vertebral fracture patients with osteoporosis in the US. Pharmacoeconomics. 2010;28(5):395-409. DOI: 10.2165/11531040-000000000-00000 . PubMed PMID: 20402541 .
  12. Delate T, Chester EA, Stubbings TW, Barnes CA. Clinical outcomes of a home-based medication reconciliation program after discharge from a skilled nursing facility. Pharmacotherapy. 2008;28(4):444-52. DOI: 10.1592/phco.28.4.444 . PubMed PMID: 18363528 .
  13. Welch EK, Delate T, Chester EA, Stubbings T. Assessment of the impact of medication therapy management delivered to home-based Medicare beneficiaries. Ann Pharmacother. 2009;43(4):603-10. DOI: 10.1345/aph.1L524 . PubMed PMID: 19318600 .


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