Medication Safety LAN Event A Review of Patient Activation and Prescription Drug Monitoring Resources to Enhance Medication Management with Patients.

Transcription

1 Medication Safety LAN Event A Review of Patient Activation and Prescription Drug Monitoring Resources to Enhance Medication Management with Patients. Wednesday, October 11, :00 4:30 PM ET 1

2 Welcome and Reminders Please be prepared for sharing and open discussion Slides and a recording from today s session can be found on: n-safety-lan-event-october-2017 Rachel Digmann, PharmD, BCPS QIN NCC Event Lead Amanda Ryan, PharmD, CGP Qsource Chat Manager

3 Agenda Housekeeping Items & Continuing Education Details Speakers Kelly Arthur, Health Quality Innovators Kimberly Cahill, Quality Insights Quality Innovation Network Risa Hayes, Telligen Quality Innovation Network Danna Droz, National Association of Boards of Pharmacy Sheila Sullivan, Appriss Health Cheryl Anderson, Atlantic Quality Innovation Network Rachel Digmann, Telligen Quality Innovation Network Facilitated Discussion Wrap-up 3

4 Learning Outcome The purpose of this session is to prepare healthcare quality improvement professionals to identify and implement effective healthcare strategies by exploring promising practices to enhance medication management. We expect that this experience will help participants demonstrate and promote successful delivery of care practices and identify opportunities for improvement, all of which may promote advances in care that impact the Medicare beneficiaries served by the work of the QIO Program. 4

5 Now Offering Continuing Education Credit Continuing education credit is available for: Physicians & Physician Assistants Registered Nurses & Nurse Practitioners Dietitians Pharmacists & Pharmacy Technicians Certificate of Attendance 5

6 Instructions for Obtaining CE Attend the entire event Complete the evaluation that will pop up at the conclusion of the event There is a separate evaluation required for CE that will load in your browser following completion of the general evaluation Once you submit your CE evaluation, you will be provided with a certificate to retain for your records For technical assistance, please Nikki Racelis (nikki.racelis@qinncc.hcqis.org) 6

7 CE Information Physicians: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians. AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physician Assistants: NCCPA accepts AMA PRA Category 1 Credit from organizations accredited by ACCME. Pharmacists: AKH Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. AKH Inc., Advancing Knowledge in Healthcare approves this knowledge-based activity for 1.5 contact hours (0.15 CEUs). UAN L04-P; UAN L04-T. Initial Release Date: 10/11/17 7

8 CE Information, Continued Registered Nurses: AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. This activity is awarded 1.5 contact hours. Nurse Practitioners: This activity has been planned and implemented in accordance with the accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: This activity is accredited for 1.5 contact hour(s) which includes 0 hour(s) of pharmacology. Activity ID # Dietitians: AKH Inc., Advancing Knowledge in Healthcare is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 1.5 continuing professional education units (CPEUs) for completion of this program/material. CDR Accredited Provider #AN008. The focus of this activity is rated Level 2. Learners may submit evaluations of program/materials quality to the CDR at

9 Disclosure of Financial Relationships & Commercial Support The planners and faculty do not have any relevant financial relationships to disclose. AKH Inc., CRW & Associates, and Telligen do not have any relevant financial relationships to disclose. No commercial support was received for this activity. 9

10 Disclosure of Financial Relationships & Commercial Support Disclosures It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review. Disclosure of Unlabeled Use and Investigational Product This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Disclaimer This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant's misunderstanding of the content. 10

11 Method of Participation You must participate in the entire activity to receive credit. A statement of credit will be available upon completion of an online evaluation/claimed credit form. The link to the online evaluation will be provided after completion of the activity. If you have questions about this CME/CE activity, please contact AKH Inc. at service@akhcme.com. 11

12 Who s in the room? What entity or type of organization do you represent? Academic Faculty Government agency (CMS, CMMI, CDC, etc.) Home Health Agency Hospital Nursing Home/LTC/SNF Patient, Family, or Caregiver Patient or Family Representative Pharmacist: Clinic Pharmacist: Community Pharmacist: Hospital Pharmacist: LTC Prescriber/Practitioner QIN-QIO staff Other (please specify in the comments field) 12

13 Session Goals By the end of today s call you will be able to Understand what the Patient Activation Measure (PAM ) is and how to apply the resource. Explain the importance of a Prescription Drug Monitoring Program (PDMP) and how to utilize within your practice. Provide access to training and resources for individual state PDMPs. Explain the application and potential patient outcomes associated with both the PAM and PDMP. 13

14 Telligen Quality Innovation Network QIN NCC Risa Hayes, CPC Program Specialist 14

15 Session Objectives Provide an overview of the Patient Activation Measure (PAM ) What is the PAM? Why it s important How you might use it Highlight projects from the field Kim Cahill, Quality Insights Kelly Arthur, Health Quality Innovators Show you how to access the PAM 15

16 What Is the Patient Activation Measure? 10 item questionnaire developed by Dr. Judith Hibbard and Dr. Bill Mahoney Measures an individual s knowledge, skills and confidence for managing their health and healthcare PAM reliably predicts ER visits, hospital admissions/readmissions, medication adherence and more. PAM activation levels are mapped to hundreds of consumer health characteristics motivators, attitudes, behaviors and outcomes for dozens of health conditions Allows providers to tailor interventions based on patient s activation level 16

17 Low activation signals problems and opportunities 17

18 A PAM score reveals an individual s position along a continuum of increasing health activation Scientifically validated measure that assesses three core domains knowledge, skills and confidence - that drive health behavior Sample Questions: #1: When all is said and done, I am the person who is responsible for taking care of my health. #10: I am confident that I can maintain lifestyle changes, like eating right and exercising, even during times of stress

19 Behavior maps provide key insights into realistic behavior change opportunities: Medication Selfmanagement 19

20 Behavior maps provide key insights into realistic behavior change opportunities: Diabetes Self-care 20

21 Current PAM Projects through QIOs Communities in more than 34 states are using or planning to use the PAM Cross-setting projects (acute, post-acute, physician) Pharmacy Primary Care/ACO Home Health, SNF, Assisted Living First-responders, fire departments, community paramedic LTAC Dialysis facilities Various target populations 21 SNF rehab High ED utilizers Mental Health High Risk Medications

22 Current PAM Projects through QIOs Continued... Target populations, cont d Rural African American, Native American, & Hispanic Those with low literacy Dementia Non-English speaking populations Interventions & Measures 22 Risk-assessment Medication self-management Coaching to increase patient activation Education to increase awareness and activation Disease Self-management measure effectiveness and activation Transitional Care Nurse programs measure effectiveness and activation

23 Quality Insights Quality Innovation Network Kim Cahill, MBA, BSN, RN Project Coordinator

24 Triple Aim, Triple Win: Using PAM-10 Kim Cahill, MBA, BSN, RN Quality Insights

25 Objectives Gain knowledge in use of PAM-10 tool to risk stratify/assist patients attending diabetes selfmanagement classes Share one intervention with potential to create a Triple Win for QINs, communities and patients

26 Impact of Patient Activation Knowledge Poorly Activated Patients are more likely have unmet health needs and feel overwhelmed with managing their healthcare Half as likely to take medications as prescribed Confidence Patient Activation Skill Frequent users of acute care Up to 90% more likely to experience a hospital readmission Insignia Health 2016

27 Triple Aim: Triple Wins Pennsylvania data consistently showing high acute care utilization for people with diabetes (DM) 34.5% total discharges with a 1 or 2 dx of DM 20.9% statewide readmission rate High ED utilization Diabetes drugs 1 of 3 drug classes targeted for ADE reduction High utilization impacts community tenure rates Communities offer resources for hosting EDC classes Community member interest in helping improve outcomes for people with DM QIN teams, Communities, and Beneficiaries Win!

28 Intervention PAM-10 administered Pre- and Post-EDC class PAMs scored and patients risk stratified identifying those requiring additional support Notify PCPs by sharing PAM informational packet PAM-10 education Patient scores Recommendation to connect with patient within 60 days QIN contact for physician questions Monitor claims data to see if visit occurs

29 Outcomes to Date Of those completing the DSME class: 72% complete pre and post PAM-10 68% have increased activation score 11.8 point average score increase (out of 100) 50% still Level 1 or 2 (low activation) post class (a-ha moment) 55% physician notification sent This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization for West Virginia, Pennsylvania, Delaware, New Jersey and Louisiana under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication number QI-PA-C

30 Contact Kim Cahill

31 Health Quality Innovators Kelly Arthur, BS, CDT Improvement Consultant

32 WISH for PAM October 11, 2017

33 ... \HQI... _... HEALTH QUAUTV NOV,r..TQRS IH 1 QI Virgini.a and Maryl.and Communities: 2[n 4-16 Recruited and In Conversation In Co 111versatio 111

34 Nexus Montgomery - Maryland Wellness and Independence for Seniors at Home (WISH) 1. One part of a four-part proactive program to reduce avoidable hospitalizations and readmissions in the county 2. Health Coaches for wellness in 42 independent senior living communities 3. Pre-post PAM questions scored` 4. Recorded in on-line PAM database (Flourish ) 5. Reports produced/reviewed for ongoing analysis 34

35 PAM : Challenges and Discoveries 1. Languages and Interpretations: a. When all is said and done b. Wording of some questions not indicative of actual conversation 2. Generational challenges: a. Tactile needs for printed PAM questions b. Face-to-face meetings vs. telephonic c. More mature coaches hired 3. Post-PAM : a. Clients do not see the need to complete b. Complete two or three visits before discharge 35

36 36 PAM : WISH Program Licenses

37 PAM-10 : Question Specific Referrals Medication Therapy Management (MTM): 18.4% to date #3) I know what each of my prescribed medications do. #6) I am confident that I can follow through on medical treatments I may need to do at home. Disease Self-Management: 10.1% to date #4) I am confident that I can tell whether I need to go to the doctor or whether I can take care of a health problem myself. 37

38 QIN-QIO Support HQI: Health Quality Innovators 1. Monthly Meetings a. H.E.A.L.T.H. Partners: Hospital Effectively Assisting Lasting Transitions to Home b. MCNIC3: Montgomery County Non-emergent Interventions and Community Care Coordination c. Nexus Montgomery 2. Educational Opportunities a. Certifications, Videos, Links 3. Quarterly Analytic Reviews a. PAM : Trends, Tracking and Truths b. Medicare Claims: Hospital and SNF Utilization 38

39 Contact HQI Kelly Arthur, BS Improvement Advisor - MD, Care Transitions karthur@hqi.solutions Carla K. Thomas, MS, CTRS, CPHQ Director, Care Transitions cthomas@hqi.solutions

40 Q & A 40 This material was prepared by Health Quality Innovators (HQI), the Medicare Quality Innovation Network - Quality Improvement Organization for Maryland and Virginia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. HQI 11SOW

41 PAM Resource available to you at no cost Through your local QIN-QIO... PAM-10 tool Coaching for Activation (CfA): web-based health coaching and protocol tool Flourish : online reporting and analysis tool Assistance with project design, measurement, intervention strategy Recorded PAM training resources Training and coaching resources Case studies QIN-QIO support Contact your local QIN-QIO for more information and access to the PAM

42 Q & A FAQs... Who has access to the data? Is PAM available in other languages? Do we have access to the Caregiver PAM What questions do you have?

43 National Association of Boards of Pharmacy Danna Droz, JD, RPh Prescription Monitoring Program Liaison

44 Who is NABP? NABP is a 501(c)(3) nonprofit association that protects public health by assisting its member boards of pharmacy and offers programs that promote safe pharmacy practices for the benefit of consumers. NABP runs consumer education campaigns on prescription drug safety as well as provides programs and other support that assist state agencies in their prescription drug abuse prevention efforts.

45 What is a Prescription Drug Monitoring Program? A PDMP/PMP is a statewide electronic database that collects designated data on specified substances dispensed to or for patients. The PDMP is housed by a state regulatory, administrative, or law enforcement agency. The housing agency disseminates information from the database to individuals who are authorized under state law to receive the information for purposes identified by state law.

46 How a Prescription Drug Monitoring Program Works

47 Why Is Something else needed? Patients live, work, and seek health care across state borders. State PMPs requested that NABP assist with state-to-state communication. Solution :

48 NABP involvement in PMP InterConnect NABP PMP InterConnect facilitates the transfer of prescription monitoring program (PMP) data across state lines. It allows participating state PMPs across the United States to be linked, providing a more effective means of combating drug diversion and drug abuse nationwide. The benefits of state PMPs are enhanced by PMP InterConnect because the system provides the means for physicians and pharmacists to more easily identify patients with prescription drug abuse and misuse problems, especially if those patients are crossing state lines to obtain drugs. Utilizing the program s connected web of information promotes appropriate intervention and assists in the prevention of substance abuse and diversion of controlled substances.

49 How PMP InterConnect Works 1. To obtain multistate data, the physician/pharmacist/other person enters a request to home PMP (PMP 1). 2. PMP 1 encrypts a message and sends to PMP InterConnect for delivery to other state(s). 3. Other state(s) decrypt(s) the message, query own PMP, encrypt message, and send to PMP InterConnect. 4. PMP InterConnect delivers the encrypted message(s) to PMP PMP 1 decrypts the message(s), prepares a report, and delivers it to the requester.

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51 Data Availability Each state selects other states with which to share PMP data. Sometimes state laws limit sharing. States share at least with all their participating border states. (Highest rate of return) All states collect Schedules II IV. Many states collect Schedules II V plus drugs of concern (gabapentin, pseudoephedrine, Fioricet )

52 PMP InterConnect Statistics Data is returned to the requesting state within seconds Every month PMP InterConnect relays 13+ million requests for patient reports 24+ million responses from other state PMPs 42 PMPs participate today (41 states + DC). NABP s goal is 50 states plus District of Columbia NO cost for states to participate in PMP InterConnect

53 Contact For more information about a PDMP please contact the state Prescription Drug Monitoring Program. For more information about PMP InterConnect, please visit Or Danna Droz at ddroz@nabp.pharmacy

54 Appriss Health Sheila Sullivan Product Manager

55 Who is Appriss? Founded in 1994, Appriss provides proprietary data and analytics solutions to address risk, fraud, safety and compliance issues for government and commercial enterprises worldwide. Appriss Health is a division of Appriss, Inc. Appriss launched a PDMP platform in 2013 called PMP AWARxE. NABP contracts with Appriss Health to operate and maintain PMP InterConnect.

56 Appriss PMP AWARxE Statistics 43 PDMPs now use Appriss to operate their platforms. (Includes states operational with PMP AWARxE and states in the migration phase from other PMP systems) Amazon Web Services design optimizes scalability, reliability, security and compliance Highly configurable to meet states diverse needs The most cost-effective PDMP platform in the market To learn more about PMP AWARxE visit:

57 Type of Services to States Modern Scaled PDMP Platform PMP AWARxE: Modern Scaled PDMP Platform PMP InterConnect: National PDMP Data Sharing Hub (as defined in previous slides) PMP Gateway: Clinical Workflow Integration Reporting and Analytics: Provider Reports NarxCare: a substance use disorder prevention and management platform

58 PMP Gateway What it does Integrates PDMP information into clinical information systems and workflow. Dramatically increases the use of PDMPs. What is the state of integration Live in 27 states through PMP Gateway. 1,300 stores integrated. PMP Gateway integrated with Epic, Cerner, Meditech, Allscripts, Nextgen, QS/1, PDX, and many more. To learn more about PMP Gateway visit: Number of states Gateway is live 27 Number of Gateway transactions per month 18 million

59 Provider Reports Provider Reports indicate the prescriber s prescribing activity over a defined time. Metric descriptions and methods of calculation are available to the PMP state agency as well as to each prescriber. Report metrics include: Number of persons for which prescriber wrote at least one (1) opioid prescription Number of opioid prescriptions written by prescriber Percentages of opioid prescriptions written by prescriber with daily MME Percentages of prescriber s patients where opioid treatment duration (days of therapy) Prescription Volumes Anxiolytic / Sedative / Hypnotic Prescribing Top medications prescribed (by generic name and as reported to the state PMP. Possible Prescriber Shoppers Possible Pharmacy Shoppers Dangerous Combo PMP Usage Provider reports are based on the specialty of prescribers registered as PMP users only.

60 NarxCare The National PDMP Information Sharing Hub NarxCare supports three distinct user groups: Provider Patients Care Teams NarxCare provides discrete SUD/PDMP data for incorporation into native EHR displays and decision support and includes: Use scores Risk scores Alerts and more NarxCare is a care coordination platform that allows for P2P messaging, care notes, referrals supporting the care of our highest at risk individuals To Learn more about NarxCare visit:

61 NarxCare Display Direct and universal pipes into EHRs and pharmacy management systems are pinnacle of care coordination

62 NarxCare Report

63 Thank you for watching! For more information about Appriss Health, please visit For general inquiries, please contact

64 Atlantic Quality Innovation Network Cheryl Anderson, BS, RPh Medication Safety Pharmacist

65 How QIN-QIOs are Supporting PDMP Efforts Cheryl A. Anderson BS, RPh Medication Safety Pharmacist October 11, 2017

66 How QIN-QIOs are Supporting PDMP Efforts Opioid and PDMP Webinar Series Pain Management Coalition

67 Interventions Make a Difference May 16 Start of Grant SCRIPTS Inquiries SC DHEC Quintiles/IMS

68 PDMP benefits to patients/caregivers Improve care and patient safety Educate not to share prescribed medication Promote proper storage and disposal of prescription medications Recognize signals that a patient may be misusing prescription medications Become informed about risk-reduction strategies for opioid overdose Refer to treatment programs

69 For More Information Cheryl A. Anderson, BS, RPh Medication Safety Pharmacist (803) The Carolinas Center for Medical Excellence This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Innovation Network Quality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 11SOW-AQINNY-TskC

70 CMM Resources The Campaign for Meds Management (CMM) PDMP state recordings Commit to Join the Campaign Share your Story Submit a Resource 70

71 Panel Discussion Facilitator Danna Droz NABP Kelly Arthur Health Quality Innovators Rachel Digmann Telligen QIN Sheila Sullivan Appriss Health Kim Cahill Quality Insights QIN Cheryl Anderson AQIN

72 Facilitated Discussion Chat in your questions and comments. Press *1 on your telephone key pad to enter the teleconference queue. 72

73 Call to Action Review the PAM and PDMP resources presented today. Identify at least one community partner who you can engage in your medication management efforts. Complete the post-event assessment upon exiting WebEx: 73

74 Save the Date! Join us for the next Medication Safety LAN Event! Wednesday, January 10, :00-4:30 PM ET Registration is required! Register at g.php?mtid=e83628dd2121f423299a8ee84a80832ac 74

75 Thank you! This material was prepared by Telligen, the Quality Innovation Network National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QINNCC /26/17 75