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Finding time between research and personal projects, Dr. Ben Urick, PharmD, PhD, was interviewed by the Sit with Senate Committee, Emily Meggs. Dr. Urick is research assistant professor at the Center for Medication Optimization in the Division of Practice Advancement and Clinical Education as well as the advisor to the UNC Chapter of the Academy of Managed Care Pharmacy. In this week’s faculty spotlight with Dr. Urick, learn about his transition from a farm to pharmacy and all of the steps in between.

Sit with Senate: How did you get into the pharmacy profession?
Ben Urick: My path was probably a little bit different than the average student at UNC. I grew up on a farm in Illinois and, like a lot of kids that grew up on farms, I thought, “I want to do what my dad does.” However, as I got older, I became interested in chemistry and, in combination with my desire to work with people, I was lead to the profession of pharmacy. During a job shadowing at my local Walgreens, I remember sitting behind the counter and asking the pharmacist, “ How do you use chemistry on a day to day basis?” The pharmacist pondered the question for a moment, then went to the shelf and pulled out a sulfamethoxazole/trimethoprim bottle. He tore off the package insert from the back, opened up the whole thing and said “this is a sulfa group.” My seventeen-year-old self was thoroughly impressed, and from that moment on I was sold.

SwS: Where did you go from there?
BU: I went into pharmacy school at Drake University through the 6 year guaranteed admissions program. From my freshman year in college, I was exposed to pharmacy through my “Introduction to Careers” courses, which are similar to your “On Becoming a Pharmacist” course. Before these courses, I was very set on community pharmacy, but then like many students, I learned about other opportunities for pharmacists and became excited about those as well. Over time, I realized that being a direct patient care provider was not something I felt passionately about. I saw how my girlfriend at the time, who is now my wife, was so ecstatic was about direct patient care and clinical pharmacy, and I just did not feel that excitement rising within me. At the same time, I had my first ever research project understanding pharmacy technician perceptions and salaries. Although the outcomes of that study were not particularly earth-shattering, it was brand new knowledge, and it was ours. I believe that it was in this moment that I finally felt as passionate about research as my wife was about clinical pharmacy. From that point, I started to think about careers more focused on research.

SwS: How did your career path lead you to your position at UNC ESOP?
BU: Pursuing my research interests, I became involved in community pharmacy payment models I eventually met Troy Trygstad, a PharmD/MBA/PhD who was the primary investigator on a large 15 million dollar project, and part of the reason that I changed my PhD dissertation in the second semester of my PY4 year. I stayed in contact with him, and when he had an opening on his team in early 2016 he offered me a position. While I was interested in his project, I had always wanted to go into academia. I contacted Dr. Joel Farley, a personal contact and faculty member of UNC, who put me into contact with the Jon Easter, the Director of the Center for Medication Optimization at UNC ESOP. We were able to put together a position for me as a research track faculty member. I dedicated 80% of my time to research and 20% to other faculty duties. We finished the Community Care of North Carolina project in August and it was a phenomenal project and fantastic experience.

SwS: What was the Community Care of North Carolina Project?
BU: The Community Care of North Carolina Project was an ambitious, federally-funded project with the goal of transforming community pharmacy practice such that pharmacists could meaningfully impact patient outcomes and spending. Medicare and Medicaid patients were the focus of this project, and there was a payment model designed to rewarded pharmacists for providing “enhanced services” to these patients. Through our “community pharmacy enhanced services network,” we pulled together a variety of community pharmacies that were interested in providing non-dispensing related patient care services or doing dispensing related patient services at a higher level. These services would be doing more than the perfunctory interaction check. The program did not specify exactly what a pharmacist was supposed to do as a part of these advanced services, but that was the general concept. One action pharmacists could do was sitting down with patients for an hour, reviewing all their medicines to come up with a medication action plan and then sending that plan to the physician. There are things that a pharmacist can do that make patients get better or stop patients from getting worse, and this program was designed to provide supports for those things and then measure the impact of that service provision on patients’ healthiness.

SwS: How did the Center for Medication Optimization fit into this project?
BU: The Center for Medication Optimization helped provide support for this project and also a home for my research assistant as well as myself. This project fits directly within the mission of the Center; as a member of the Center, I had the Center’s name recognition as well as our own sort of channel and branding, and the ability to drive some impact, and this is greater than anything I would have had access to as an individual researcher.

SwS: What were the outcomes of this project?
BU: This project actually birthed a for-profit company that is reproducing this sort of network design across the country with the goal of accomplishing the same sorts of things. Our work did not find that there was a  reduction in healthcare spending, but there was a major improvement on adherence, which you would think eventually would lead to changes in outcomes.

SwS: On what future innovations will the Center for Medication Optimization be focused?
BU: In terms of other work with the Center for Medication Optimization, there is a lot of different types of projects. We are exploring different collaborations with the healthcare system across the street [UNC Hospitals], and we are exploring collaborations with different community pharmacy practitioners across the state, focusing on things like opioid use, and specialty pharmaceuticals, which are driving a large amount of healthcare spending today.

SwS: And your future focus within the Center?
BU: There a lot of quality measures that are being used to modify pharmacy payments. For example, the majority of Medicare Part D plans modify Part D payments based on pharmacy adherence scores. The problem is that these scores may not be representative of the actions a pharmacist is undertaking. My goal is to refine quality measurement for community pharmacies such that the measures we use to measure performance, and design values-based payment models, are actually indicative of performance.

SwS: So, how are you going to keep refining these quality measures?
BU: My next big project will analyze the contributions of physicians and pharmacists to shared medication related quality measures. Individually, both pharmacists and physicians have been shown to affect adherence. However, we currently have little evidence on the relative impact of pharmacists and physicians on measures like adherence. Physicians are increasingly exposed to value based payment models, which modify physician payments based on patient outcomes such as adherence. Since we know that pharmacists can impact on adherence, it is possible for a pharmacist to collaborate with a physician to attempt to comanage adherence. Unfortunately, in these situations, it is not always so clear as to how much a pharmacist should get paid because the role of the pharmacist is not always clear. By my research, we hope to be able to measure the relative impact of pharmacists and physicians on shared quality measures. This research could potentially be used as a part of contracting to justify a certain amount of payment for pharmacists.

SwS:  What makes you passionate about pharmacy? What makes you want to get up in the morning and do the job that you are doing?
BU: A lot of what makes me passionate about pharmacy is the idea that there is a lot of medication related opportunity that exists. There is a combination of good things that are not happening and bad things that are happening because of how patients use their medications. I think that pharmacists, particularly community pharmacists, are an untapped resource. If you can create payment models and infrastructure that supports pharmacists providing those services, you will see an overall impact of those pharmacists on those patients and improved population health overall.

SwS: What makes ESOP special to you? How is it different?
BU: From my perspective, the amount of research, support of research and the philosophy surrounding research that exists within the faculty and the administration has driven a lot of growth in the school within the last 10 years. It is a very different environment than many other schools of pharmacy and as a researcher, it is a very enriching environment to be a part of. On that note, we have a great foundation for the education that is provided in the the classroom through research in education practices. Currently, the innovative curriculum is progressive in a way that empowers students to learn better while focusing on the experiential aspects of education, which are critical in this transition from a layperson to a well-educated pharmacist.

SwS: What are your hobbies?
BU: I do a bit of biking and jogging. I like to cook as well as brew beer. I play trombone, baritone, and dance in a German fest band, and that has taken up the last four out of my last five weekends. We put on a great Octoberfest. It is a riot.

SwS: What advice do you have for the current student?
BU: Speaking from personal experience, and this advice has also been given to me by others, it is very good to have a plan. It is very good to have something that guides you and gives you a bit of gas to fuel the fire as you progress through pharmacy school, but it is also very good to change that plan when needed. Find a path, be passionate about pursuing that path, and be willing to change it when you need to change it. If you can really get that down, that can make a student very successful. Figuring out when to change that plan is part of the challenge.

SwS: You went from one farm to a completely different “pharm.” How did you make your decisions about transitioning career paths with confidence?
BU: Finding that professional and personal network that can help to be a guide is critical.
On the professional side, finding people around you that support you and your goals is critical to feeling confident, or at least supported, in your decisions. Personally, I find that I need to talk things out with someone. As I was going through every transition point, I have always had to reach out to mentors, friends and family members to bounce ideas off of them. Mentorship is incredibly important. The time to use a mentor is not when you need a mentor. Getting to know a faculty member in a genuine way through something like a research project or simply seeking their advice on something during your PY1 year is imperative to creating solid mentors in your PY3 year that can help guide you effectively to help you decide if you should change your path. On the personal side, finding a life partner who can be a guide for you just as you are for them is also very important. If it was not for my wife, who was my girlfriend in pharmacy school, I may still be asking myself, “Should I get a PhD?”

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