Q: What is a “Patient Self Management” program?
A: In 2003, the Institute of Medicine defined self-management
support as “the systematic provision of education and supportive interventions
by health care staff to increase patients’ skills and confidence in managing
their health problems, including regular assessment of progress and problems,
goal setting, and problem-solving support.” Simply stated, a "Patient Self
Management Program" provides you with education so that patients become a more
active part of their health care team. When patients become more involved in
their health care, the result is that patients will be healthier and more
Q: What qualifies a pharmacist to coach patients?
A: Today, all graduating pharmacists receive their Doctor of
Pharmacy degrees from an accredited institution, which constitutes approximately
six years of schooling. Many pharmacy graduates opt to complete a one- to
two-year residency program, and some continue on to complete a fellowship in a
specialized area of practice. As a result, pharmacists receive six to ten years
In addition to college, residencies and fellowships, many pharmacists complete
certificate programs that focus on a specific chronic condition. LPIHO requires
that any pharmacist participating in the program complete a certificate program
for the chronic disease module(s) in which they wish to participate as a coach.
Q: If one of my clients decides to enroll into one or both of the
programs offered by LPIHO, what are the carrier’s responsibilities?
A: The carriers are responsible for the following:
Providing a ZIP code analysis for the patient population for whichever disease
state(s) is being implemented. This allows LPIHO know where pharmacist coaches
will be needed.
If reduced or waived copays is the incentive the employer chooses to offer, the
carrier will need to discuss with the LPIHO Care Team how this process will work
Carriers will need to provide baseline data (12 months prior to start of
program) as well as annual data thereafter (once every 12 months) in format
agreed upon by all local carriers
Q: How will I know when a ZIP code analysis is needed?
A: Your client (employer group) will request this directly from
Q: How will we know when reports need to be run?
A: Your client (employer group) will make a formal, written
request to both medical and prescription claims, along with signed consent from
each participant to release their data. All forms required to release such data
have been reviewed and approved by the major carriers in Lancaster County.
Do you have questions or concerns that were not addressed here?
If so, please contact a member of LPIHO’s Care Team