Feature Medication Adherence

Transcription

1 Version No: 3.0 Feature Medication Adherence

2 CONTENTS CONTENTS... 2 AUDIENCE INTRODUCTION WORKFLOW MEDICATION MANAGEMENT FOR ADHERENCE (TYPES OF MESSAGES) Medication Adherence High Risk Medication Missing Medication SURESCRIPTS ACCELERATOR Proportion of Days Covered (PDC) ACCESSIBILITY OF MEDICATION ADHERENCE IN PROGNOCIS Medication Adherence on Face Sheet Medication Adherence on Prescription screen Medication Adherence available as a menu option under menu: Messages11 6. STEPS TO BE TAKEN BY PROGNOCIS IMPLEMENTERS Enable Surescripts services for Medication Adherence Enable Provider(s) for Medication Adherence Browser settings for accessing Surescripts Accelerator

3 AUDIENCE PrognoCIS Users and Implementers 1. INTRODUCTION PBMs (Pharmacy Benefit Manager), Surescripts, and EMRs together play an important role in the Patient Care process. There are instances when Patients do not adhere to the prescriptions prescribed by Providers they either leave the medication course mid- way or do not pick up their refills. It could also happen that Rx has medication that could affect his/her health adversely or a medication that is required to be prescribed for the Patient s diagnoses has been missed out in the Rx. The PBMs have valuable information of cases such as these, which is now utilized for deliverance and interaction with Providers at critical points in the care process. PBMs report such cases to Surescripts in form of messages which are promptly reported to Providers using EMR. 2. WORKFLOW Refer to figure 2.1 to understand the workflow between the PBMs Surescripts and PrognoCIS EMR Figure 2.1 3

4 3. MEDICATION MANAGEMENT FOR ADHERENCE (TYPES OF MESSAGES) PrognoCIS has seamlessly integrated functionality of Medication Management with Physician workflow. Following are the type of messages displayed to Users: 3.1 Medication Adherence Scenario: Kara has been prescribed medication along with its refill. But she doesn t finish her course and drops it mid- way and does not bother to pick up her refill. When medications are not being properly taken. An adherence message, as indicated by claim activity, occurs when a patient is not taking the medication as frequently as prescribed. Surescripts notifies the patient s Provider by sending across a message through the Surescripts Accelerator. Refer to figure Figure 3.1-1: Surescripts Accelerator popup displaying Medication Adherence alert message 3.2 High Risk Medication Scenario: Lane is a 73 year old elderly patient who has been prescribed a non- benzodiazepine hypnotic medication in his prescription. Long- term use of non- benzodiazepine hypnotic medication is not recommended as tolerance and addiction can occur. It should be specifically avoided in elderly patients. 4

5 When a patient has been prescribed a drug that is considered high- risk due to the potential for side- effects where alternative drug therapies exist. This is brought to the notice of the Prescriber through messages sent on Surescripts Accelerator. Refer to figure Figure 3.2-1: Surescripts Accelerator popup displaying High- Risk Medication alert message 3.3 Missing Medication Scenario: when a medication which is required but has been missed in the Rx. When a Patient has been prescribed with medications but a medication that is expected to be present based on a Patient s diagnosis codes is missing in the Rx, or if there is existence of another drug. 5

6 Figure 3.3-1: Surescripts Accelerator popup displaying Missing Medication alert message 4. SURESCRIPTS ACCELERATOR Accelerator is a medium provided by Surescripts that has been seamlessly integrated and implemented in PrognoCIS. Refer to figure 4-1 Surescripts Accelerator enables users to - View medication management adherence messages. - View the patient s adherence summary, PDC (Proportion of Days Covered explained in section 4.1) ratio Submit a response to a medication management adherence message. Allow worklist tracking to manage tasks requiring attention. Manage delegation of responsibilities among providers (prescribers and their staff) by providing role- based access controls. 6

7 Figure 4-1: Surescripts Accelerator popup invoked within PrognoCIS 4.1 Proportion of Days Covered (PDC) PDC is defined as the total number of days a medication is in the possession of a patient for each fill of a prescription. The PDC value provided by the PBM/payer is calculated on the basis of the fill date(s) and days supply for each fill of a prescription. A PDC ratio is provided by the PBM on a monthly basis for cholesterol, diabetes and hypertension regardless if the PDC is below or above 80%. Following are the three categories (distinguished with color code) Table 4.1-1: No. Color code Percentage of adherence OR PDC (Proportion of Days Covered) 1. Lowest ratio <= 60% 2. Lowest ratio > 60% and < 80%, 3. Lowest ratio => 80% Figure 4.2-1: Categories of PDC Ratio on Surescripts Accelerator 7

8 5. ACCESSIBILITY OF MEDICATION MANAGEMENT FOR ADHERENCE IN PROGNOCIS Medication Management for Adherence feature is available or accessible from multiple screens and in different forms, 5.1 Medication Management for Adherence on Face Sheet Navigation Goto patient s Encounter à Encounter TOC à Face Sheet The feature has been implemented on Face Sheet as an alert and an individual cell dedicated to Medication management for Adherence, the details are as follows: i. Medication Management for Adherence alert on Face Sheet Based on the eligibility fetched for a Patient and availability of Medication Management messages, an alert is displayed on Face Sheet. The popup displays the first three available Medication Management messages for the Provider and the Lowest PDC score. Refer to the following figure Figure 5.1-1: Medication Management popup displaying alert on Patient s Face Sheet 8

9 For Medication Management for Adherence Face Sheet alerts to be applicable, the property value should be MA for the property, facesheet.showalert.fortypes ii. Note: The alert is displayed once per session of the User i.e. only if the User has logged out then on the User s next login is the alert seen. Once closed, on refresh, the alert is not displayed. New Face Sheet cell introduced A new Face Sheet cell for Medication Management for Adherence has been introduced that displays information coming from PBM based on Patient s active eligibility plan and availability of Medication Management messages. Refer to figure

10 Figure 5.1-2: Newly introduced Face Sheet cell Medication Management for Adherence Note: Because the information is fetched dynamically, Users may face delay of few seconds before the details are displayed on the Face Sheet cell and for the display of Face Sheet alert. 5.2 Medication Management for Adherence on Prescription screen Navigation Goto patient s Encounter à Encounter TOC à Prescription screen On the Prescription screen, the Medication Adherence button, Med Adhere has been added that invokes the Surescripts Accelerator. Refer to the following figure Figure: Surescripts Accelerator available on Prescription screen 10

11 5.3 Medication Adherence available as a menu option under menu: Messages Navigation Goto menu: Messages à Med Adherence A sub- menu, Med Adherence allows Users to view messages of multiple Patients from a single screen of Surescripts Accelerator. Refer to figure Figure 5.3-1: A click on Med Adherence sub- menu displays messages of multiple Patients A User associated with multiple Providers is able to view all the received messages on a single screen of Surescripts Accelerator. And the logged- in User has provision to respond back to the messages if the User has the submitter rights assigned. Note: A User is associated to multiple Providers/Physicians from Provider Master (Goto menu: Settings à Configuration à Provider à click Med Adhere button à Medication Adherence master); also Surescripts Service levels (Medication Adherence, High Risk Medication, and Missing Medication) have to be enabled for the Provider. The sub- menu, Med Adherence is visible only for Users with roles having Read access rights (Goto menu: Settings à Configuration à Role à select a role à select menu option: Medication Adherence à select Read access rights). 11

12 Note: PBM (Pharmacy Benefit Managers) manages sending of messages based on the urgency of message. If message is very urgent then the message is available under the Messages à Med Adherence. It is then the Provider s responsibility to respond to the message. If the Provider fails to respond then at the time of Patient s next encounter, the message would again be displayed in the Patient s encounter. For example, if a Patient has been non adherent (has a low PDC score) and the refill is past due then such a Patient is at risk so in such a scenario, PBM sends the message to the Provider. If the Patient comes in for a visit and the message has not been acted on then the message will also appear for the Patient s encounter. Limitation: Currently, Surescripts facilitates even Users with Read rights to respond back to Medication Adherence messages. Hint: Medication Adherence messages belonging to patients can also be accessed from their respective encounters. 6. STEPS TO BE TAKEN BY PROGNOCIS IMPLEMENTERS 6.1 Enable Surescripts services for Medication Adherence Navigation Goto menu: Settings à Configuration à Provider link, under Users menu à Provider Master screen à erx button 12

13 Figure 6.1-1: Highlighted services are the ones to be selected Following are the options of Surescripts services that are required to be selected for the respective medication adherence messages to be displayed to the User: 1. Medication Adherence to display Surescripts medication adherence related messages on the Surescripts Accelerator when a Patient hasn t adhered to the Prescription. 2. High Risk Medication to display Surescripts High Risk medication related messages on the Surescripts Accelerator when medications that may turn out to be a high risk (in consideration with Patient s diagnoses, age, and other factors) has been prescribed for a Patient. 3. Missing Medication to display Surescripts missing medication related messages on the Surescripts Accelerator when a medication that is expected to be present based on a Patient s diagnosis codes, is missing in the prescription. 4. Proportion of Days Covered (PDC) to display the PDC for a Patient on the Surescripts Accelerator. Note: Depending upon the option(s) selected the respective medication adherence message(s) are displayed on the Surescripts Accelerator. 6.2 Enable Provider(s) for Medication Adherence Navigation Goto menu: Settings à Configuration à Provider link, under Users menu à Provider Master screen à Med Adhere button 13

14 A Provider is enabled for Medication Adherence from the Provider Master screen. A button named Med Adhere has been added to the Provider Master Refer to figure Figure 6.1-1: Medication Adherence Master popup On click, Medication Adherence Master popup is displayed and Access rights for Users associated to the Provider are done from the Medication Adherence Master popup. Note: Only Providers who have the Edits rights to the Provider Master screen have access to Medication Adherence Master popup. Access rights to Users associated to the Provider is done via the Medication Adherence Master popup. - The Search icon on the User column invokes the Physician search listing out Users such as Clinical Staff, Biller, Doctor, Medical Assistant, and Office Staff. Refer to figure Figure 6.1-2: Physician search icon 14

15 Note: The maximum Physicians allowed for selection is Users are assigned with roles such as View and Submit, these roles, define the role of these associated Users as either Submitters or Viewers of messages. Refer to figure Figure 6.1-3: Options to define the User as a Viewer or Submitter - If a User is assigned with Submitter role then the User has rights to respond to such messages. Refer to figure Figure 6.1-4: A User assigned with Submitter role has the permission to submit response to Medication Adherence messages - If a User is assigned the Viewer role then the User is only able to view the Medication Adherence messages and not respond to it. 15

16 Figure 6.1-5: Viewer role does not have provision to submit response to the message 6.3 Browser settings for accessing Surescripts Accelerator 1. Add Surescripts website, *.surescripts.net to the browser s trusted site. Refer to figure Figure

17 2. Ensure the Settings options of the browser are selected as depicted in the figure. Refer to figure Figure Hint: v For the functionality to work the Patient should have eligibility and the Provider should be enabled for Medication Adherence. v A User from admin login cannot see the functionality of Medication Adherence; also the functionality is NOT applicable for FS encounter v Medication Adherence feature is currently available nationwide. v Messages not attended to will automatically expire after 30 days and will be removed off the accelerator. 17