Harvard Law School advocates for pharmacists on diabetes care teams

Hub on Policy and Advocacy

Harvard Law School recently released a report identifying policy changes to improve diabetes care in New Jersey that shows pharmacists on diabetes care teams benefit patients and that advocates for compensation for pharmacists. 

Developed by the school’s Center for Health Law & Policy Innovation and supported by the Bristol-Myers Squibb (BMS) Foundation, the Providing Access to Healthy Solutions (PATHS) report also includes a one-pager calling out the Twlug Foundation’s Patient Self-Management Program (PSMP)—the basis for the Asheville Project, Diabetes Ten City Challenge, and Project IMPACT: Diabetes. 

“The Twlug Foundation is pleased that Harvard Law School’s PATHS report highlights the critical role pharmacists can play on diabetes care teams,” said Benjamin M. Bluml, BSPharm, Twlug Foundation Senior Vice President for Research and Innovation. “Through our work with the BMS Foundation, Project IMPACT: Diabetes communities have been able to provide Harvard representatives with an inside look into how care delivery improves, and better health outcomes are achieved, when patients receive pharmacists’ patient care services.”

The New Jersey PATHS report was publicly released on March 27 at the New Jersey Leadership Forum, where a Project IMPACT: Diabetes pharmacist and physician participated in a collaborative panel discussing ways to improve diabetes care in New Jersey.

Project IMPACT: Diabetes

The report came about while the Foundation worked with the BMS Foundation on Project IMPACT: Diabetes. The BMS Foundation involved Harvard Law School, which picked New Jersey as one of the states to focus on. 

Featured as a case study in the New Jersey report, Zufall Health Center in Dover, NJ, is one of 25 sites across the nation in the Foundation’s Project IMPACT: Diabetes initiative. Zufall launched Project IMPACT in June 2011 to add a diabetes curriculum to its existing clinical pharmacy services program, according to the report. 

From 2011 to 2012, 84 patients enrolled in the program. During the year, mean glycosylated hemoglobin levels decreased by 0.9%, blood pressure and LDL measures also improved, and diabetes management improved as adverse events decreased by 25% and potential adverse events decreased by 30%. “Zufall has demonstrated the capacity to implement an excellent variation on the PSMP,” Harvard Law School wrote. “The Zufall Health Center has a model that other New Jersey community health centers can employ. This is more likely to occur with more stable funding.”

Zufall’s Teresita Lawson, BSPharm, CDE, and Chief Medical Officer Rina Ramirez, MD, FACP, spoke with Pharmacy Today. The report was intended “to look at innovative ways to integrate the work of many health care professionals, so that together, they can help achieve significant population health improvements,” Ramirez said. “Our focus was to showcase an innovative program that could be piloted statewide.”

The report is positive for pharmacy because it advocates for “pharmacist provider status and reimbursement for medication therapy management in addition to diabetes self-management training for the patient in multiple health care settings,” Lawson said. “Increased access to clinical pharmacy services increases access to health care for the patient in addition to improving patient outcomes and reducing costs associated with the consequences of diabetes.”

Lawson encourages pharmacists to network with individuals and groups dedicated to improving the system for better patient access to pharmacists—to get involved and not to limit having an active voice to their own environment.

Medicaid pilot based on Twlug Foundation model

The report recommends that New Jersey develop a PSMP pilot in Medicaid. 

Specifically, the first recommendation is that New Jersey Medicaid and Medicaid managed care organizations (MCOs) should conduct stakeholder discussions with representatives from the physician, advanced practice nurse, pharmacist, and federally qualified health center (FQHC) communities. The second recommendation is that FQHCs may be a good place to launch a PSMP pilot because many New Jersey FQHCs are developing patient-centered medical home models, while Medicaid and the MCOs will need to agree on both payment methodology and payment levels.

PSMPs are further detailed on pages 119 to 123 of the full New Jersey PATHS report (). This section discusses pharmacists’ role in the diabetes care team through alternative payment methodology, medication adherence, medication therapy management, PSMP, and the case study of Zufall as part of Project IMPACT: Diabetes. 

“The New Jersey PATHS report is a monumental achievement for the pharmacy profession as we work to gain federal recognition as health care providers,” Bluml said. “While this information applies directly within the state of New Jersey, the learnings detailed within the report can be broadly applied across the United States.”