Achieving Wisconsin Pharmacy Quality Collaborative (WPQC) Certification

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1 Achieving Wisconsin Pharmacy Quality Collaborative (WPQC) Certification Improving outcomes, safety, communication while reducing costs and promoting pharmacist services Jessica Johnson, PharmD/MPH Candidate

2 Overview Introduction Access Community Health Center Wisconsin Pharmacy Quality Collaborative Background Methods Results Discussion Conclusion Acknowledgments

3 Introduction to the Site William T. Evjue Clinic

4 Access Community Health Centers Access Clinics provide health services to low income and medically underserved communities 23,092 patients served (Dane County Residents) 5 Locations throughout Dane County (Wingra, South Side, WTE, Dodgeville, Sun Prairie) Federally qualified healthcare centers Services offered by William T. Evjue Clinic: Medical Dental Behavioral Health Pharmacy 120 scripts/day 1.5 FTE RPh, 2 FTE CPhT

5 ACHC Pharmacy William T Evjue Clinic Pharmacy receives 340(b) drug pricing Estimated 20 50% discounted pricing Patient Assistance Program (PAP) enrollment Sliding scale discount Emergency dispensing drug list Drug sample inventory Primary Access for Kids (PAK) Pharmacy open only to clinic patients

6 Project Background

7 Background

8 Background Health Effectiveness Data and Information Set (HEDIS) Health plan performance measured Part of National Committee for Quality Assurance accreditation

9 Background Many of the aforementioned problems with HEDIS goals stem from medication use issues, such as: Poor compliance/adherence Inappropriate dosing Lack of monitoring for efficacy and safety Lack of knowledge on how to use a medication device Drug interactions

10 Pharmacist Professional Services What are these? Level 1:

11 Adherence Services

12 Comprehensive Medication Review (Level 2)

13 Comprehensive Medication Review

14 Financial Trends Third party reimbursement on a decline Independent community pharmacies trending toward operating on a loss

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16 What is the Wisconsin Pharmacy Quality Collaborative? Collaborative between community pharmacies, payers, and a professional pharmacy organization with common goals Goals: improve quality and reduce costs Promote safe and effective use of medications to improve patient outcomes Promote pharmacy best practices Promote pharmacy professional services Streamline billing of professional services

17 Why Become WPQC Certified? Provides structure for non product based services Resources and training for providing professional services Certification is required for some services within an insurance plan (e.g. Level 2 and Medicaid) A requirement for a pharmacy hosting 4 th year pharmacy students Represents pharmacy best practices

18 What are the Potential Benefits for Access Pharmacy Increased revenue from insured patients (medical assistance) Improve patient outcomes, which will benefit the clinic as a whole Demonstrate the need for services promoted by WPQC to justify additional staffing Advance pharmacy practice

19 Methods Identify and define WPQC network certification requirements Assess current implementation of requirements and barriers to implementation Develop strategy for compliance with network requirements Implement strategy Evaluate

20 In Progress Results

21 WPQC Quality Based Network Requirements Medication history conducted on all new patients or patients who fill medications at multiple pharmacies Consistent verification and documentation of allergies and adverse drug reactions Consistent documentation of weight and dose/weight or dose/body surface area for pediatric patients (<12) Use of a standard show and tell for each patient s medication

22 WPQC Quality Based Network Requirements Use of at least two unique identifiers for each new prescription order and upon consultation when patient is unknown to pharmacist Implementation of a continuous quality improvement (CQI) program for medication risk management Establishment and maintenance of standards for communicating and executing Class I drug recalls and necessary actions pertaining to FDA drug safety alerts

23 Pre Implementation Status

24 Strategy Brief Medication History for new patients using multiple pharmacies; scanned into dispensing software (not yet assessed) Allergies and adverse drug reactions to be screened at pickup window Weight based dosing documented on prescription hard copy Continuous Quality Improvement spreadsheet developed to review error trends

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29 Discussion Barriers Need for pharmacists role to change Certification/Accreditation trends in the industry

30 Barriers Communication barriers between technicians and pharmacists and management Overcome with more group meetings Staff buy in perceived to be below average due to current workflow challenges Workflow is continuously addressed and is being experimented on; overcoming this will depend on crosstraining, which has been discussed Current patient population is already taxing on limited resources and few patients are insured Many of the changes can occur during off peak hours in the pharmacy (error reporting, documentation, MTM billing)

31 Barriers Patients with Medicaid insurance have the same copayments regardless of pharmacy used, so no incentive to use Access pharmacy Patients with limited amount of time, transportation issues Other insurances generally not found due to the nature of the clinic

32 Role Change

33 Role Change

34 Trends March 1, 2012 National Association of Boards of Pharmacy (NABP) and American Pharmacists Association (APhA) announced formation of Center for Pharmacy Practice Accreditation Consensus based standards for accreditation of community pharmacies To include: Safe dispensing of medications Patient care CQI programs Education efforts RPh and CPhT status verification

35 Conclusion MTM via WPQC certification provides a needed service to all patients, but particularly to those with limited resources and understanding of their medications and disease states WPQC certification is an ongoing process that is being completed slowly but steadily by staff, which is encouraging Staff has initially appeared receptive to the new error reporting system and process, particularly if the spreadsheet can be updated during slower periods at the pharmacy

36 Acknowledgments Many Thanks To: Barbara Duerst, RN, MS Sharon Weisenberger, PharmD Robert Breslow, RPh, BCPS Gladys Briggs, RN, PhD Rick Kleckler, RPh LeAnn Taylor, CPhT Beata Staszak, CPhT