4/23/2014. Disclosures. Learning Objectives. Questions We ll Answer. The $300 Billion Problem. It s Time for Pharmacy to Bring Solutions

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1 Disclosures Healthier Patients, Improved Star Ratings What Medication Synchronization Can Do for Your Patients and Your Pharmacy Business Bri Morris is the Associate Director of Strategic Initiatives with NCPA. The conflict was resolved by peer review of the slide content. Bri Morris, Pharm.D. Associate Director, Strategic Initiatives National Community Pharmacists Association Learning Objectives Describe how a med sync program can improve patient outcomes and improve star ratings. Discuss how a med sync program can positively affect pharmacy operations. Outline three staffing/workflow considerations needed to begin a med sync program. Questions We ll Answer Why should I care about adherence? What s in my adherence toolbox? What is medication synchronization? How can synchronization help my patients and my pharmacy? What resources are available to help me? The $300 Billion Problem For years, emphasis has been placed on the problem of medication non-adherence $290 billion a year in direct and indirect costs 69% of medication-related hospital admissions due to poor adherence 75% of total health care spending on chronic disease It s Time for Pharmacy to Bring Solutions Transformation of health care delivery (quality vs. quantity) Government is recognizing financial value of medications Hospitals are being penalized for readmissions Result: Adherence is key part of Medicare plan ratings, ACOs, and other new payment models 1

2 Adherence: Key Part of Part D Plan Ratings Why Plans Care About Star Ratings CMS developed 5-star rating system to measure plans Ratings are posted on Plan Finder ( Five-star plans receive: High-performing icon Special Enrollment Period Medicare Advantage plans can earn Quality Bonus Payments (QBPs) Note: Does not apply to stand-alone PDPs Star Ratings: Background Average Star Rating for PDPs: 2013: ~ : Medicare contracts have been identified as low performers Identified as 2.5 stars or less over the previous 3 years Why does this matter to me? Star Ratings: Background How will PDPs and MA-PDP plans raise their Star Ratings? Choose pharmacies that are committed to improving Star Ratings measures to be a part of their network, offer them incentives, etc. What will happen to pharmacies who don t meet this challenge? Payers Focus Areas High risk medications Diabetes patients taking ACE/ARB s Medications Confirmed as Cost Saver Studies show that increased pharmacy spending results in fewer hospitalizations and lower health care costs Congestive Heart Failure: 8.4 to 1 ROI Adherence Oral diabetes medications Hypertension (RAS antagonists) Cholesterol (statins) Diabetes: 6.7 to 1 ROI Hypertension: 10.1 to 1 ROI Dyslipidemia: 3.1 to 1 Roebuck MC, Liberman JN, Gemmill-Toyama M, Brennan TA. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Affairs 2011;30(1):

3 Spend a Little Save a Lot Why Community Pharmacists? Congressional Budget Office estimates that a 1 percent increase in the number of prescriptions filled would cause Medicare s spending on medical services to fall by roughly 0.2% That s savings of $1.7 billion More trips here can mean fewer visits here. Trusted medication experts Most accessible provider in community Key touch point throughout continuum of care Last health care professional seen by patient before medications are taken Patient s connectedness with pharmacy is the leading predictor of adherence 1 Offsetting Effects of Prescription Drug Use on Medicare s Spending for Medical Services. Congressional Budget Office. November Medication Adherence in America: A National Report Card. National Community Pharmacists Association. April Align Clinical and Business Case Adherence First fill counseling Utilize pharmacy reminder systems, such as calling programs Key Point: First fill counseling is the key to adherence improvement. Utilize ways to improve outcomes during the hospital discharge process Chronic care patients need you and you need them Diabetes patients spend $4,500-$12,000 annually per year (top 1% spends $28,000 in the pharmacy) As you align your pharmacy with quality measures, there are additional revenueproducing opportunities to be found What s In Your Adherence Toolkit? What Is Medication Synchronization? Adherence Services Adherence counseling (first fill, etc.) 48% Compliance packaging 41% Synchronized refills 39% Medication Synchronization: Coordinating all of a patient s prescription medications to be filled on the same date each month Refill reminders (phone or text) 39% Motivational interviewing 13% Source: 2013 NCPA Digest, sponsored by Cardinal Health 3

4 Medication Synchronization Is Not Auto Refill Synchronization: Win-Win-Win Patients receive a monthly call from their pharmacy to discuss their medications and answer any questions about dosing instructions and/or potential side effects. Pharmacy confirms whether patients need each medication before dispensing it. Pharmacy asks patients about any recent physician visits or hospitalizations that may have resulted in a new medication or change in therapy. Automatic Refills No No Synchronized Refills Patients opt in to receiving this service. Not always Patients have the option to pick up their medications from their local community pharmacy. No Not always Improves patient care by: Reducing gaps between refills Providing mechanisms to identify non-adherence Reducing medication-related hospital readmissions Improves pharmacy operations by: Resulting in more prescriptions filled Changing dispensing function from reactive to proactive Synchronization Improves Pharmacy Ops Allows You to Work Smarter, Not Harder What you can expect: Streamlined workflow Predictable workload Decreased delivery runs Better inventory control More time for other pharmacy services Professional satisfaction Loyal patients Healthier bottom line What you won t miss: Manic Mondays Frequent flyers Last-minute refill requests on Friday afternoons or before holidays Reversing for no shows Patients running out of pills Floating IOUs Improved inventory control Just-in-time ordering Increased velocity: 12 to 36x/yr Better cash flow Improved bottom line Increased prescription volume (30%) Reduced pharmacist hours (10 hrs/week) Reduced delivery costs Opportunities for add-on sales (OTC, etc.) Implementing Medication Synchronization Start-up procedures Refill synchronization process Ongoing program operations Getting Started Choose a program manager Dedicate a staff member tasked with coordinating the program Lead technician may be a good candidate Will be pulling patient files, calling the patient to discuss and review medications, and making notes for the pharmacist Organizational skills are important Should have solid understanding of medications Determine program procedures/protocols Engage staff 4

5 Free Tools/Resources Identifying Patients Appointment Based Model (ABM) ABM manual, brochure, doctor letter/fax, patient agreement, supply list, call sheet, etc. Free on NASPA website ( Simplify My Meds Operations manual, patient forms (enrollment, contact, etc.), physician letter/fax Marketing kit (bag stuffers, brochures, poster) Free to NCPA members ( Something for everyone: Those on complex regimens Those with simple regimens who forget to request refills High-maintenance patients Elderly patients with difficulty driving Home-bound patients (saves delivery costs!) Busy professionals and caregivers who can t get to the pharmacy New medication starts Action Synchronization: How It Works 1. Determine and list the chronic monthly prescriptions the patient will be taking. 2. The medication with the highest copay should become the anchor prescription. 3. Calculate the quantity needed for each medication to synchronize it with the anchor prescription. Example Lisinopril 20mg daily (due 4 th ) Crestor 20mg daily (due 16 th ) Metformin 500mg BID (due 22 nd ) Crestor 20mg (due 16 th ) Lisinopril 20mg (12 tablets) Metformin 500mg (50 tablets) 4. Contact the patient s prescriber, explain your coordinated refill program, and request two prescriptions for each synchronized medication: One for the quantity required for synchronization A second for the normal monthly quantity 5. Short fill the appropriate prescription(s) to synchronize with the anchor prescription. Document on the hard copy the one-time short fill was for adherence program. Paying for Short Fills Request override from PBM Increasing recognition of importance of adherence 2014: Changes to Part D program Patient pays out of pocket Waive copay (if permissible) Physician samples ALTERNATIVE: Refill early for 2-3 months to synchronize with anchor medication Part D Plans to Allow Sync in 2014 New Submission Codes Will Help All Part D plans now institute daily cost-sharing in 2014 Calculate a pro-rated copay for short fills Applies to all drugs dispensed for < 30 day supply Limited to oral solids Does not apply to antibiotics Rejection and Override Codes NCPDP developed two new Submission Clarification Codes to prevent rejections Codes will allow the pharmacy to: Notify the plan of the shortened day s supply fill Bypass refill too soon edits Dispensing Fees Likely to be addressed in pharmacy contracts 5

6 Program Mechanics Final Fill Procedures 7 Days Prior Pull patient files 7 days ahead of their refill date Call patient to review meds; ask about recent hospitalizations/physician visits 3-7 Days Prior Review for prescriptions with zero refills Update the patient profile in the dispensing system 1-2 Days Prior RPh reviews orders and resolves any clinical issues identified by the program manager Review inventory/order products Dispense product(s) Call and remind patient to pick up prescriptions Tips from the Experts NCPA Study Designate a technician to run the daily operations Leverage your software Identify non-adherent patients Group patients by sync date Reports to help with patient calls Test it out with 5-10 patients first Engage your front-line staff (they re your best marketers!) 10 Pharmacies Nationwide Ateb Time My Meds 6-month study 103 Additional days on therapy Day refills/year Average patient on 6 medications 20 extra prescriptions/patient/year Start Small; THINK BIG! What Your Peers Are Saying Synchronization is a great foundation for these additional services: Compliance packaging Medication calendars Immunizations Transitional med programs with local hospitals (Walgreens WellTransitions ) CMR/MTM Disease State Management I ve been a pharmacist for 50 years, and in business for 40. This is one of the best ideas I ve seen in a long time. My staff received a new patient & 25 prescription transfers yesterday. The patient had been calling all over the county looking for a service like this! We have been doing this for nearly 3 years now with great success. Nearly 20% of our patients participate with satisfaction and adherence at or near 100%. The patients and the doctors love it! The doctors see it as an extension of the service of their own practice. The competition just scratches their heads. 6

7 Questions? Bri Morris, Pharm.D. Associate Director, Strategic Initiatives National Community Pharmacists Assn. Tel: (703)