Episode 3 Transcript

Host
Welcome to Voices in Pharmacy Innovation, the podcast where we spotlight bold ideas and groundbreaking practices that are transforming pharmacy practice and healthcare delivery. I'm Dave Dixon, professor and chair at the Virginia Commonwealth University School of Pharmacy and core faculty member of the Center for Pharmacy Practice Innovation. In each episode, we'll sit down with pharmacists, healthcare leaders, and change makers who are rethinking how pharmacy can improve patient care and push the boundaries of what's possible in our profession. Together, we'll share stories, explore new models of practice, and amplify the voices driving pharmacy innovation forward.

Host
Today, we're joined by Dr. Marie Smith, the Henry A. Palmer Endowed Professor of Community Pharmacy Practice and Assistant Dean for Practice and Public Policy Partnerships at the University of Connecticut School of Pharmacy. She’s also an affiliate faculty member of our Center for Pharmacy Practice Innovation. Dr. Smith has been a national leader in advancing roles for pharmacists in community-based settings and has worked with multiple state and national policymakers to address healthcare delivery issues involving medication management programs, patient safety, performance measures, health information technology, and the integration of clinical pharmacists into advanced primary care practices. Over the past several years, our profession has made significant progress by successfully advocating for legislation that expands pharmacists’ scope of practice and creates pathways for reimbursement for the services we provide. Of course, there is still important work ahead, and I know Marie will have valuable insights into how we move forward. I'm excited to have her on the podcast today, so welcome, Marie.

Guest
Thank you so much, Dave. I'm glad to be here.

Host
You’re an excellent person to have on to talk about this topic because you’ve spent your career working on these issues and have been an immense leader in this space. Before we get into the details, give our listeners a sense of your background—how you got into the profession and what inspired the work you do.

Guest
My interest actually started when I was a young child. I remember our family having tremendous respect for a local community pharmacist, and it captured my attention early on. In high school, I worked in a local hospital and did volunteer work. My pharmacy career really started when I was a pharmacy student working as an intern at a community hospital. After earning my bachelor’s degree in pharmacy from the University of Connecticut, I completed a hospital pharmacy residency at Thomas Jefferson Hospital in Philadelphia. From there, I came to Richmond to earn my PharmD at what was then the Medical College of Virginia, now part of VCU.

While I was there, two faculty members—Tom Reinders and Jim McKinney—really inspired me. They were ambulatory care practitioners, and I found that direct patient care in a team-based clinic setting was incredibly rewarding. That led to several early academic positions. I worked at the University of Tennessee, returned to MCV as faculty, and later worked at Rutgers and Eastern Virginia Medical School. My roles were primarily as a clinician, practitioner, and educator. Eventually, I shifted into national association work and spent several years at the American Society of Health-System Pharmacists, working in professional affairs and policy-related roles.

Host
You’ve done a tremendous amount of work advancing pharmacy practice. What are some of the key lessons you’ve learned along the way when trying to implement innovative pharmacy practice models?

Guest
One important lesson is that you can do great research, but it doesn’t mean everyone will immediately implement your program. That’s where implementation science becomes important. We’ve learned that you often can’t go in with a rigid idea of what you want to implement. Instead, you need to meet practices where they are and address the needs they identify, even if you know it may not be the most effective model at first. For example, we worked with a large federally qualified health center in our state that wanted to hire a full-time pharmacist using a population health model. The pharmacist would review patient populations and send recommendations to physicians rather than seeing patients directly. Although we believed a collaborative practice model would ultimately be more effective, we started where they were comfortable. After a few months, the physicians appreciated the pharmacist’s recommendations but realized it created more work for them because they still had to review everything and take action.That experience helped them recognize the value of embedding a pharmacist with collaborative practice authority. The pharmacist could directly manage medications and ultimately save physicians time while improving productivity.

Another major lesson relates to payment for pharmacist services. Even if legislation allows pharmacists to bill for services, that doesn’t mean payment systems are easy to implement. In Connecticut, we’re one of only six states with no payment from commercial insurers or Medicaid for pharmacist patient care services. Much of our work now focuses on advocacy and policy efforts to change that.

Host
I think you touched on an important point with implementation science and the challenges that come even after legislation changes. Here in Virginia, pharmacists can bill Medicaid, but the process is complex and requires registration with multiple Medicaid providers. So even when the legislative environment improves, implementation remains a challenge. Looking ahead, how do you see the role of pharmacists in primary care evolving over the next five to ten years?

Guest
I think both the public and physicians increasingly recognize that pharmacists can do much more. Physicians who have worked closely with pharmacists often say they want a pharmacist available to them, either embedded in their practice or accessible on demand. One model we’ll likely see more of is a shared resource model. In this model, a pharmacist works across several practices within a health system rather than being dedicated to a single clinic. For example, one full-time pharmacist might rotate among several practices located within a short geographic radius. This approach can be very cost-effective.

We also need to rethink the community pharmacy model. During COVID-19, the public saw pharmacists providing testing, vaccinations, and other services. Many states have expanded scope of practice to include services like test-and-treat or contraceptive prescribing. Community pharmacies could become a frontline healthcare access point in many communities. Technology will also play a role. Remote patient monitoring tools—such as digital blood pressure monitors, glucose monitoring devices, and other connected technologies—allow pharmacists to follow patients more closely between physician visits. The technology exists. What we need are payment systems that support pharmacists providing these services.

Another opportunity is in rural health. Community pharmacies are often the most accessible healthcare resource in rural areas, and new federal investments in rural healthcare could expand pharmacists’ roles there.

Host
I completely agree, especially regarding the opportunities for community pharmacists and the potential role of technology. Let’s transition to a few closing questions. What resources have influenced your thinking about innovation in pharmacy practice?

Guest
Within pharmacy, state and national pharmacy organizations are incredibly important resources. Outside the profession, I spend a lot of time following work in health services research and health policy. One organization I recommend is AcademyHealth. They host an annual Dissemination and Implementation Conference that focuses on implementation science. It’s a great learning opportunity for people interested in translating research into practice.

Host
That’s a great recommendation. What’s one small change pharmacists can make today that could have a big impact on advancing their role in primary care?

Guest
Advocacy is key. Pharmacists should work with their state or national pharmacy organizations to advocate for payment for pharmacist services. Invite legislators to visit your practice site so they can see firsthand the care pharmacists provide. Once they see the work pharmacists actually do, their understanding of the profession often changes dramatically. Another option is writing an op-ed for a local newspaper about an issue affecting pharmacy practice in your state.

Host
What advice would you give to students or early-career pharmacists who want to work in this area?

Guest
Students should explore ambulatory care opportunities during their rotations. Residency programs now include many ambulatory care and community pharmacy training opportunities. I truly believe ambulatory care will be one of the fastest-growing areas for pharmacist careers in the future.

Host
I couldn’t agree more. What are you most looking forward to in the next six to twelve months?

Guest
Personally, warmer weather. Professionally, I’m focused on advancing legislation in Connecticut that would allow payment for pharmacist clinical services.

Host
That’s fantastic. Thank you so much for joining us and sharing your insights.

Guest
Thank you for having me.

Host
And thank you to our listeners for tuning in to this episode of Voices in Pharmacy Innovation. If you enjoyed today’s episode, please subscribe, share it with a colleague, and join us next time.

Host
Voices in Pharmacy Innovation is published monthly. You can listen on Apple Podcasts, Spotify, or by visiting our website linked in the show notes.