Medicare Part D Member Satisfaction of the Comprehensive Medication Review. Katie Neff-Golub, PharmD, CGP, CPh WellCare Health Plans

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1 Medicare Part D Member Satisfaction of the Comprehensive Medication Review Katie Neff-Golub, PharmD, CGP, CPh WellCare Health Plans 1

2 Disclosure Statement Disclosure Statement: These individuals have the following to disclose concerning possible financial or personal relationships with commercial entities (or their competitors) that may be referenced in this presentation. Katie Neff-Golub nothing to disclose

WellCare Health Plans, Inc. Company Snapshot OUR PRESENCE Founded in 1985 in Tampa, Fla.: Serving 3.8 million members nationwide. 339,000 contracted health care providers.

3 WellCare Health Plans, Inc. Company Snapshot OUR PRESENCE Founded in 1985 in Tampa, Fla.: Serving 3.8 million members nationwide. 339,000 contracted health care providers. 70,000 contracted pharmacies. Serving 2.4 million Medicaid members, including: Aged, Blind and Disabled (ABD). Children s Health Insurance Program (CHIP). Family Health Plus (FHP). Supplemental Security Income (SSI). Temporary Assistance for Needy Families (TANF). Serving 1.4 million Medicare members, including: 349,000 Medicare Advantage members. 1 million Prescription Drug Plan (PDP) members. Serving the full spectrum of member needs: Dual-eligible populations (Medicare and Medicaid). Managed Long Term Care (MLTC). Spearheading efforts to sustain the social safety net: The WellCare Community Foundation. Advocacy Programs. Creation of Public-Private Partnerships. Significant contributor to the national economy: A FORTUNE 500 and Barron s 500 company. 6,600 associates nationwide. Offices in all states where the company provides managed care. Data is per the last reported quarter, ending June 30, 2015 All numbers are approximated. Updated: September 18,

What We Do Reduce Cost and Improve Quality and Access for Government Health Programs by: Providing managed care services targeted to government-sponsored health care programs, focusing on Medicaid,

Managed Long Term Care Medicaid Dual- Eligible Members Serving a variety of people including families; children; and the aged, blind and disabled; includes a focus on low-income, dual-eligible

4 What We Do Reduce Cost and Improve Quality and Access for Government Health Programs by: Providing managed care services targeted to government-sponsored health care programs, focusing on Medicaid, Medicare and Prescription Drug Plans. Managed Long Term Care Medicaid Dual- Eligible Members Serving a variety of people including families; children; and the aged, blind and disabled; includes a focus on low-income, dual-eligible populations. WellCare Improving quality of care, increasing health care access and improving outcomes for members. Relieving providers of administrative work and hassles. Prescription Drug Plans Medicare Advantage Providing cost savings for government customers and taxpayers. Medicare Supplement Data is per the last reported quarter, ending June 30, 2015 All numbers are approximated. Updated: September 18,

5 Serving Dual-Eligible Members More than 40% of our Medicare Advantage plan members are eligible for both Medicare and Medicaid. The Value of Dual-Eligible Integration Improves care coordination and member satisfaction by incorporating provider partners. Leverages health information infrastructure to facilitate care coordination. A single capitated payment for all services offers the most significant savings potential for state and federal governments. Simplifies care delivery for providers by providing a single integrated source for claims payment. Offers shared savings opportunities for providers through the delivery of quality care. Characteristics of Dual Eligibles 66% have 3+ chronic conditions. 54% have cognitive/mental impairment. 15% reside in long-term care facilities. 50% self-report fair/poor health. Twice as likely to have multiple emergency room visits and multiple inpatient hospital stays in a year million Americans were eligible for both Medicaid and Medicare in million were age 65 or older. 4.2 million were under 65 and disabled. Data is per the last reported quarter, ending June 30, 2015 All numbers are approximated. Updated: September 18,

WellCare s MTM Program Enrollment criteria for WellCare s MTMP Three (3) or more chronic diseases Seven (7) or more chronic Part D prescription medications Expected annual prescription spending as

6 WellCare s MTM Program Enrollment criteria for WellCare s MTMP Three (3) or more chronic diseases Seven (7) or more chronic Part D prescription medications Expected annual prescription spending as defined annually by CMS ($3138 for 2015) Services include, but not limited to: Comprehensive Medication Review (CMR) Conducted Telephonically by Pharmacists Appointments scheduled by Pharmacy Technicians Personal Medication List/Medication Action Plan mailed after review Targeted Medication Reviews Quarterly Educational Newsletter Knowledge Base Website Pharmacy Staffed Hotline 6

7 Key Service Offering Comprehensive medication reviews (CMRs) are the cornerstone of Medication Therapy Management services (MTM). Required by Centers for Medicaid and Medicare Services (CMS) Pharmacist, Physician, or other healthcare provider review of all medications (prescription, nonprescription, and dietary supplements) to determine appropriateness of each medication and ensure that the patient is taking them correctly to avoid drug-related problems^ Greatest Variable: Participation Key concerns: Member Awareness Perceived need/ benefit Experience ^Sound Medication Therapy Management Programs, Version 2.0. Journal of Managed Care Pharmacy. Jan 2008(1)

8 Path to Success What is the definition of success for an MTM program? CMR Completion Rate? Drug-Therapy Problem Resolutions? Member Satisfaction? How can markers for success be utilized for continuous quality improvement in an MTM program? Procedure and process changes Staff development and assessment Member retention plan and program 8

9 Objectives Discuss the role of a satisfaction survey in MTM Review current literature regarding member satisfaction of MTM programs Discuss two-year survey results of our MTM program Outline the utilization of survey results in: Continuous quality improvement efforts Staff improvement Examine the future of member satisfaction surveys in the MTM population Benchmarking against peers? Star measure? 9

10 Customer Satisfaction Surveys Definition of Satisfaction Survey: The process of discovering whether or not a company's customers are happy or satisfied with the products or service received from the company. May be conducted face to face, over the phone, via or internet, or on handwritten forms. Customer answers to questions are then used to analyze whether or not changes need to be made in business operations to increase overall satisfaction of customers. 10

11 Customer Satisfaction Surveys Definition of a Satisfaction Survey The process of discovering whether or not a company's WellCare Health Plan s MTM program customers members are happy or satisfied with the products or service (Comprehensive Medication Review) received from the company. May be conducted face to face, over the phone, via or internet, or on handwritten forms. Customer answers to questions are then used to analyze whether or not changes need to be made in business operations to increase overall satisfaction of customers. Where Customers = Members (Patients) Services = Comprehensive Medication Review 11

12 Rationale for measuring satisfaction Member/Patient experience is thought to be too subjective or mood oriented and not related to real clinical outcomes However, patient experience correlates with the following: Improved Safety Improved Health Outcomes Reduced resource use (i.e. hospitalization) Research supports the need for including member/patient experience as one of the central pillars of healthcare quality Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 013;3:e doi: /bmjopen

13 Current Literature Study Setting Results Moczygemba LR et al. Research in Social and Administrative Pharmacy 6(2010): Kim S, Martin MT, Pierce AL. Satisfaction With Medication Therapy Management Services at a University Ambulatory Care Clinic. Journal of Pharmacy Practice. I Medicare Part D Telephonic MTM program University MTM Clinic 80% response rate Most patients satisfied Most common request: help with drug cost 95.4% response rate (n = 65) Overall Satisfaction with the MTM Clinic was high 50% patients responded great & 30% responded good Overall satisfaction with MTM pharmacists found to be significantly positively correlated with overall satisfaction with the MTM clinic. (p < ) Patients taking 11 meds were significantly more satisfied with services than patients taking 10 meds (p = ) Most common comment of what they liked the least was waiting time Coming Soon! Moon et al. J Manag Care Pharm. (in press) 13

Survey 6-question survey with additional comment box Uses a Likert scale : Strongly agree Strongly disagree Survey Analysis: Unanswered survey questions =

14 Survey 6-question survey with additional comment box Uses a Likert scale : Strongly agree Strongly disagree Survey Analysis: Unanswered survey questions = neutral Multiple responses to a single question = least favorable option Additional comments taken verbatim Delivery Method: Mailed with MAP/PML after CMR completion 14

15 Surveyed Population WellCare Health Plans, Inc. MTM program members Medicare Advantage Prescription Drug (MAPD) plan Prescription Drug Plan (PDP) Received a telephonic CMR N = 21,105 Female 66.44% (14,023) Average Age Average Number of Medications (per month) Average Number of Chronic Diseases (per month) 69 ± 11 years ± ± 2.93 Average Cost (per month) $ ± $1,

16 Results 92.65% overall favorable response in all 6 categories Overall Response Rate: % N = 8,722 WellCare CMR Survey Responses Question 1 Question 2 Question 3 Question 4 Question 5 Question 6 Favorable Neutral Not - Favorable % Favorable 97.00% 96.00% 95.00% 94.00% 93.00% 92.00% 91.00% 90.00% 89.00% 88.00% 87.00% 86.00% Survey Results Received 7/1/13-7/31/15 16

17 Survey Results: Q1 17

18 Survey Results: Q2 18

19 Survey Results: Q3 19

20 Survey Results: Q4 20

21 Survey Results: Q5 21

22 Survey Results: Q6 22

23 What have we done with results? Continuous Quality Improvement Initially Identified Opportunities: Standardized Questions: Improve member understanding of the MAP/PML Improve member understanding of the benefits of sharing their MAP/PML with all healthcare providers Comment Section: Improve pharmacist knowledge on herbals Operational Adjustments Made: Changes made to the CMR call Ensure that member understands what they will be receiving as result of CMR (PML & MAP) Clearly explain benefits of sharing MAP/PML with their healthcare team Resources/Training to staff References provided for herbal products including drug-interaction reports Coaching/Training based on member s feedback 23

Survey Results Existing Areas of Opportunity Based on Member Comments: Members want to know if their medications interact Members desire information regarding administration (i.e. timing and can their meds be taken together?

24 Survey Results Existing Areas of Opportunity Based on Member Comments: Members want to know if their medications interact Members desire information regarding administration (i.e. timing and can their meds be taken together?) Members want to know brand/generic names of all meds not just brands Members want advice regarding ways to reducing cost of medications 24

Survey Results Advantages: Ability to tie survey result to MTM provider Listen to telephonically recorded call provides opportunities for coaching Establish some objectivity to a subjective process,

25 Survey Results Advantages: Ability to tie survey result to MTM provider Listen to telephonically recorded call provides opportunities for coaching Establish some objectivity to a subjective process, allowing for: Staff benchmarking and institution of performance metrics that can be tracked and trended Limitations: Confusion with scale Language barriers Member understanding of the service Possibility of bias: Member comments related to overall health plan Participants view of response effect on pharmacist/representative No anonymity 25

26 The Future Pharmacy Quality Alliance (PQA) Mission: To improve the quality of medication management and use across healthcare settings with the goal of improving patients' health through a collaborative process to develop and implement performance measures and recognize examples of exceptional pharmacy quality. One of 10 Measure Concepts in Development in 2015 MTM-Part D: Use of Patient Satisfaction Survey following CMR completion Current Progress: In draft status with Measure Development Team (MDT) 26

27 PQA Draft Measure: MTM Satisfaction Description: Survey to evaluate patient experience with CMR Survey asks about experience with a specific pharmacist/provider Results combined to measure health plan s performance Eligible Population: 18 years and older Patients enrolled in the MTM program who are identified as eligible for a CMR and received the CMR (or who received an MTM service of which the CMR is a standard component) Denominator: Completed and returned surveys Numerator: TBD 27

28 PQA Draft Measure: MTM Satisfaction Instrument: Health-system Alliance for Integrated Medication Management Survey (HAIMM) Short (10 questions) relevant, validated, reliable Evaluate for health literacy (challenging) Translated in Spanish (needs evaluation) Cover letter and demographic questions are optional Use of vendors: 3 rd party vendors recommended to generate the standardized data necessary for comparisons 28

29 PQA Draft Measure: MTM Satisfaction Denominator Exclusion: Hospice Cognitive Impairment and long-term care (LTC) not excluded Sample Size Random sample of at least 1200 patients with a goal of achieving 360 completed surveys (assuming 30% response rate) Collection Mode: flexible mode, within 30 days Mail (could be sent with Standardized Format) Telephone with mail or telephone follow-up In-person immediately following CMR with return envelope (could be provided with Standardized Format) 29

30 HAIMM Survey Likert Scale 10 Questions: 1. My clinical pharmacist helped me to understand why I am taking each of my medicines 2. My clinical pharmacist helped me to understand how to know if my medicines are working 3. My clinical pharmacist made certain that my medicines are safe (knowing possible side effects of my medicines and avoiding drug interactions) 4. My clinical pharmacist helped me find easier ways to take my medicines 5. My clinical pharmacist helped me understand the best ways to take my medicines 6. My clinical pharmacist is working as a team member with my other health care providers 7. After talking with my clinical pharmacist, I feel more confident to manage my medicines 8. My clinical pharmacist listened to concerns about my medicines 9. I would recommend my clinical pharmacist to a family member or friend 10. Overall, how would you rate the quality of care and services you received from the clinical pharmacist? 30

31 HAIMM Survey 31

32 Conclusion Member experience can be considered one of the central pillars of healthcare quality Member satisfaction of MTM services, notably the CMR, can be utilized for: Continuous quality improvement initiatives for an organization s program Performance management In the future, member satisfaction of MTM services may be used: To benchmark providers and/or plans As a CMS display or star rating measure 32

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Partnering with Public Health Departments in Managed Care. THIS AREA CAN BE LEFT BLANK or ADD A PICTURE

Partnering with Public Health Departments in Managed Care THIS AREA CAN BE LEFT BLANK or ADD A PICTURE 2/3/2017 The Value of Medicaid Managed Care States Have Seen the Value of Medicaid Managed Care 75