Presentation Title. Speaker Names. Together, We re Building a Better Way to Care For Everyone

Transcription

1 Presentation Title Speaker Names Together, We re Building a Better Way to Care For Everyone

2 Patients

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4 WPQC Fundamentals Network of pharmacies with certified pharmacists who provide medication therapy management (MTM) services to patients PSW accredits WPQC pharmacies based on a set of 7 quality-based best practices Team-based care focus

5 Retooling the Community Pharmacist from Medication Dispenser to Medication Therapy Manager to Improve Health and Reduce Health Care Costs

6 CMS Grant Challenges to overcome, but afforded luxury of infrastructure Clinical & Operations Managers Academic Evaluation Team Clinical Advisory Group Steering Committee Regional Implementation Specialists (4)

7 WPQC: Regional Implementation Specialists Joylyn Moore (608) Sara Lynn Peterson (608) Anh Nguyen (908) Jessica Benjamin (608)

8 Program Expansion South Central WI expansion to entire state Benefits of WPQC Membership Development and implementation of policies and procedures Clinical and programmatic resources Education and training materials Health Information Technology (HIT) platform Accreditation/certification processes

9 WPQC-Accredited Pharmacies

10 WPQC-Certified Pharmacists

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13 Attributes of Success

14 WI ForwardHealth Level I/II Interventions Q Q2 Q Level II CMR/A Services Q4 Q5 Q6 Q7 Q8 Q9 500 Q10 Q11 Q12 0 U1 Cost Effectiveness U2 Three- Month Supply U3 Dose/Dosage Form/Duration Change U4 Focused Adherence U5 Medication Additions U6 Medication Deletions U7 Medication Device Instruction U8 In-Home Medication Management UA Initial Assessment UB Follow- Up Assessment

15 April May 2015 Pharmacies providing at least one WPQC service Level I or Level II; Push and Pull N = 16,404 Documented in Aprexis 280 Pharmacies 80 pharmacies out of 360 pharmacies submitted no claims Commercial and Medicaid members

16 23% 37% 19% 19% 2% Boscobel Pharmacy Hayat Pharmacies >400 >10 >100 >50 <10 # of interventions (n=16,404) Aurora Pharmacy #1099

17 WPQC Outcomes Program focus: Asthma, Diabetes, Chronic Heart Failure, Geriatric Syndromes Clinical cases pushed to pharmacy queues The push process works Pharmacies need to respond and complete pushes and continue to identify pulls

18 Push Process Steps Pharmacist Reviews Push Pharmacist Accepts Push Patient Accepts Service Physician Approves COMPLETE PUSH

19 Tremendous Opportunity: Pushes Projected Completion Rate Level I Services 71% 48% Level II (CMR/A) Services Actual Completion Rate 13% 12%

20 WPQC Sustainability Comparably smaller number of WPQC claims submitted for commercial plans vs. WI ForwardHealth Commercial plans have stretched internal cost of administering the program over a small number of claims Concern about long term sustainability WI ForwardHealth has seen a decline in medical costs and slight increase in pharmacy costs

21 Barriers and Strategies Lack of time/staffing model Difficult to modify dispensing workflow Not profitable Lack of clinical confidence Lack of utilization of technology confidence Patient acceptance Streamline provision of services MTM workgroup curriculum Workflow resources to promote efficiency Targeted hands-on disease-state trainings Targeted technology trainings Marketing and prescriber outreach training and materials

22 Challenges Overcome Lisa Boerner, PharmD, RPh Lakeview Pharmacy, Racine WI Kate Hartkopf, PharmD, RPh UW Hospital and Clinics Pharmacy, Madison WI Ann Moore, RPh Aurora Pharmacy #1300, Wautoma WI

23 WPQC Video

24 UW SOP WPQC Evaluation Team David Mott, PhD, FAPhA, RPh Kwame Bernard, Data Analyst Lori Allerson, Graduate Student, Data Analyst Kevin Look, PharmD, PhD

25 You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. ~ Buckminster Fuller

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27 Presentation Title Speaker Names Together, We re Building a Better Way to Care For Everyone