Julie Groppi, PharmD, FASHP
PBM Assistant Chief Consultant for Clinical Pharmacy Practice and Policy
Veterans Health Administration, VA Central Office
April 1, 2022
Spreading the word: New VA web-based resource center shares road-tested insights for integrating clinical pharmacists
The Department of Veterans Affairs Pharmacy Benefits Management (PBM) Clinical Pharmacy Practice Office (CPPO) recently launched a new PBM Service website. Of particular note is the new CPPO section, which highlights the ways in which clinical pharmacist practitioners (CPPs), support comprehensive medication management (CMM). A Resources and Tools section describes the clinical pharmacist practitioners’ (CPP) roles and impact across multiple practice settings.
We invited Julie Groppi, PharmD, FASHP, to talk about the new site. She works at the Veterans Health Administration, VA Central Office as the national PBM Assistant Chief Consultant for Clinical Pharmacy Practice and Policy. In this role, she focuses on the development and integration of policy, practice and programs that model the optimized role of CPPs as advanced practice providers. She also serves as executive lead of the GTMRx Practice and Care Delivery Transformation Workgroup.
GTMRx: Tell us about the new pharmacy benefit management practice CPPO web-based resource center.
Groppi: We wanted to create a resource to share some of the strong practices that VA has developed for integrating clinical pharmacist practitioners into our interprofessional teams. We have embraced the approach of optimizing teams with clinical pharmacists — whom we term “clinical pharmacist practitioners” — since the mid-1980s. They have an advanced scope of practice and can prescribe medications.
Our office focuses on leveraging the expertise of the CPP anywhere medications are a priority — which is just about everywhere. Colleagues inside and outside the VA always ask us to share this information more broadly. So, the tools we’re making available on the website help care teams deal with trying to integrate clinical pharmacists.
GTMRx: So these tools aren’t just for the VA?
Groppi: No. In fact, we intended them to be for external audiences. Many of these documents were adapted from ones that we use within our own healthcare system to promote the value of and describe how to best integrate a CPP into the practice area. We wanted to share them with other practices and systems.
Our office started back in 2010 with that vision in mind — to expand the reach of embedding clinical pharmacist practitioners as the medication expert into interprofessional team-based settings and spreading that practice across the country.
We have a wealth of experience to share with other who want to adopt a similar model. We’re one of the largest integrated health care systems, with over 5,000 CPPs functioning across our 170-plus VA medical centers and thousands of clinics across the country. And so, we want to share that experience with others who want to adopt a similar sort of model.
GTMRX: Why is it important to launch this now?
Groppi: I think in this moment where we’re all struggling, we realize there are provider shortages. We realize that our patient’s medications are not optimized. We realize the risks for patients — and the cost to the health care system — are enormous. We really need to look at new strategies. And so, we have always embraced embedding comprehensive medication management as a primary role for our pharmacists. We wanted to position the VA as that lead, as a gold standard and model for other organizations.
GTMRx: Tell us about some of the other resources on the site.
Groppi: For this initial version of the website, we focused on what we term “fact sheets,” which are intended for physicians, the medical team and health organization leadership. They describe the role, reasonings and rationale for embedding CPPs. They were created over time by subject matter experts who are CPPs themselves working across the VA. They describe the different types of models and services that exist within the system.
The Fact Sheets include information about the numbers, showing what these models have been and the growth that we have seen over time in each area. When you look at the fact sheets, you’ll see a tremendous growth, especially over the last 10 years. More teams are adopting this model to care for their patients because of the value that they see in the VA’s CPP integration.
We try to describe it fully so other facilities and organizations can use our work as an example, and then put their own thumbprint on it. Then it becomes a tool to use with their own facility or health care system.
We’ve also developed what we call “evidence bibliographies.” Everyone else always wants to know, “Well, why would I do this?” They want to know the evidence to support having a CPP in a particular practice area — whether it be the acute care setting, as champion of antimicrobial stewardship or in the primary care setting.
These evidence bibliographies are a comprehensive review of some of the different examples that exist within the VA and are available in peer-reviewed literature. So, we felt that was a strong companion to the fact sheets and could be used successfully by others.
In the health care system, we always are looking to peer-reviewed literature and evidence to support reasoning as to why we need to invest in services. And so, this has always been a key component to helping to advance clinical pharmacist practitioner integration.
GTMRx: So how does putting all this out there support CMM integration?
Groppi: For one thing, our CPPs truly embrace CMM and understand that it’s a team sport. It’s never about the individual, but our experience shows how adding this one individual, the CPP, to the team really does make a difference by helping to save time. You’re helping to reduce provider burden because you have that medication expert embedded and co-located, working collaboratively with the team. The CPP is ensuring our patients achieve the goals that they desire — not only what the health care organization desires, but what they desire.
When you think about the whole health approach, it starts with the patient; it starts with conversation with that patient about what’s most important to them. And CMM allows us to introduce and promote whole-health concepts into the health care environment.
GTMRx: Shifting gears a bit, tell us about your involvement in the creation of the GTMRx national resource center and the consumer and physician (FAQs & infographic) toolkits.
Groppi: I’ve been co-leading the Best Practices and Innovative Solutions Subgroup and serving as the VA executive lead for the Practice Tansformation and Care Delivery Workgroup. This is right in my ballpark. This is where I live every day because this is exactly what I do within the VA system.
As with the VA organization, we’re describing the important roles, how the team works together, how they can better care for our patients and really the roles of the CPP in care delivery. And so, our workgroup team has been focusing on developing the resources for the consumer, physician and employer toolkits.
We’re describing it in easy-to-understand terms appropriate for each audience.
What does comprehensive medication management mean for the patient? What does having a clinical pharmacist as part of the team mean for the physician? For the employer, what’s the return on investment for these services?
This has really been a great collaboration over the last two to three years with GTMRx, to be able to share different resources that have been created and different methodologies for embedding CMM into their health care organization.
One of challenges GTMRx faces is how to get organizations to invest in services. And I think when we think about comprehensive medication management, it’s sometimes daunting. It’s not a well-understood term. It’s not a well-utilized term. A physician doesn’t say, “I do CMM,” right? No, they practice medicine. Nurses don’t say they contribute to CMM: They say they provide services that support the patient and the team.
It’s been a challenge within our own profession to describe that we assume roles for CMM while not being the only one providing CMM. No single person provides CMM services.
What I’d love to see how GTMRx can support a better understanding of CMM and help to connect practices together and think about mentoring programs, sharing successful teamwork strategies and bringing together successful programs with those that are just starting out and working through the steps of the process.
