Pharmacists Improve Care Through Team Collaboration

Transcription

1 Pharmacists Improve Care Through Team Collaboration Trista Pfeiffenberger, PharmD, MS Director, Network Pharmacy Programs Community Care of North Carolina

2 Disclosure and Conflict of Interest I am an employee of Community Care of North Carolina, a primary care case management company that works with over 1,800 NC primary care practices and operates several provider networks, including the NC Community Pharmacy Enhanced Services Network. I am the project coordinator for CCNC s CMMI Health Care Innovations Award (round 2, category 3): Optimizing the Medical Neighborhood: Transforming Care Coordination Through the North Carolina Community Pharmacy Enhanced Services Network (CPESN). The contents of this presentation are solely the responsibility of the author and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

3 Objectives At the conclusion of this program, the pharmacist and technician will be able to: 1. Discuss emerging opportunities for community pharmacy in value-based systems of care - What market factors are driving these changes? - What types of payers and partners are part of the new landscape? 2. Describe how community pharmacy s effectiveness will be measured 3. List examples of services that allow community pharmacy to thrive in a team-based, pay-for-performance world

4 Pre-Test Questions 1. What type of organizations should be seen as potential payers within the new healthcare landscape? 2. What types of performance measures will best help community pharmacy advertise its value to other members of the health care team? 3. What are examples of services that can improve the outcomes of prescription drug use?

5 Discuss Emerging Opportunities for Community Pharmacy in Valuebased Systems of Care What market factors are driving these changes?

6 Health Care Financing as We Currently Know It Pharmacy Ecosystem Healthcare Delivery Ecosystem Hosp Clinic Rx HH CM Pharmacy Benefit Manager Medical Benefit Manager

7 What s the problem with the way it is? The core issue in this healthcare crisis is we can t afford it anymore. So we have to increase the value of the care that we deliver. Improving value is the only real solution verses cost shifting or restricting services. Adapted from Harvard Business Review Webinar The Strategy that Will Fix Health care (20601) Featuring Harvard Business School Professor Michael E. Porter and Press Ganey CMO Dr. Thomas H. Lee Sept. 24, Slide courtesy of Joe Moose, Moose Pharmacy, Concord NC

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9 Tenets of Health Reform Reduced Cost Shifting and Increased Sharing of Risk Increased Focus on Prevention Increased Accountability Increased Cross-Setting and Inter-Entity Collaboration Increased Capture, Exchange and Application of Data (to accomplish all of the above)

10 Fundamentally Different Approach to Payment and Care Delivery

11 Optimal Medication Use Is an Investment

12 The Key to Future Success and Sustainability in a Value Driven System of Reimbursement/Financing Single = Double = Triple = Anti-HTN Prescribed Anti-HTN Filled Anti-HTN Filled and Taken Home Run = BP < 140/90 Grand Slam = Patient Hospitalization Avoided

13 Discuss Emerging Opportunities for Community Pharmacy in Valuebased Systems of Care What types of payers and partners are part of the new landscape?

14 The Medical Neighborhood

15 As of August 2016 A New Player in Value-Based Purchasing: PhRMA

16 Payer Types to Consider Managed Care Organizations (MCOs) Accountable Care Organizations (ACOs) Commercial health plans Pharmaceutical manufacturers Self-insured employers Medicare Advantage plans Other

17 The Average Chronically Ill Medicare Beneficiary

18 What do chronically ill patients have standing in the way of optimal outcomes from their medications? Lack of coordinated care among multiple prescribers Barriers like transportation that prevent optimal medication adherence Health literacy challenges, cognitive deficits, or lack of caregiver supports that require pill box fills, special packaging, changes to the medication regimen, special instructions/labeling (e.g., pictograms) Difficulty managing multiple chronic medications that can be improved with med sync +/- packaging Medication regimen that is complex or requires close monitoring, detailed education, or follow up Specialized medication use needs such as naloxone access and education, pre-filled oral syringes, etc

19 Why is community pharmacy part of the answer? CCNC Enrollees with total Enrollees on Enrollees on Enrollees on Medication CCNC Enrollees medical cost > $10,000 CCNC Priority list TC Priority list Management Priority list Total number of members 1,348, ,529 17, ,241 6,377 Total medical cost $ 4,078 $ 27,527 $ 23,813 $ 18,215 $ 25,345 # of Inpatient visits Inpatient costs $ 369 $ 3,464 $ 5,337 $ 2,924 $ 6,456 # of mental health inpatient vi ED visits ED cost $ 178 $ 745 $ 1,262 $ 816 $ 1,657 Outpatient visits Mental health outpatient visits PCP visits Pharmacy visits Pharmacy costs (Pre Rebate) $ 721 $ 5,177 $ 3,342 $ 4,298 $ 6,183

20 List Examples of Services That Allow Community Pharmacy to Thrive in a Team-Based, Pay-for-Performance World

21 - 1,800+ Medical Home Practices Pregnancy Medical Home Practices Care Managers Pharmacists - Plus Behavioral Health, Palliative Care, Chronic Pain, etc - And now, 262 community pharmacies North Carolina Medical Home Landscape

22 North Carolina CPESN Overview Goal: Create a network of community pharmacies who are willing to provide enhanced services and coordinate care with the broader care team - Official network launch in April Open network which includes 262 NC community pharmacies as of 8/1/2016

23 What do chronically ill patients have standing in the way of optimal outcomes from their medications? Lack of coordinated care among multiple prescribers Barriers like transportation that prevent optimal medication adherence Health literacy challenges, cognitive deficits, or lack of caregiver supports that require pill box fills, special packaging, changes to the medication regimen, special instructions/labeling (e.g., pictograms) Difficulty managing multiple chronic medications that can be improved with med sync +/- packaging Specialized medication use needs such as naloxone access and education, pre-filled oral syringes, etc Medication regimen that is complex or requires close monitoring, detailed education, or follow up

24 North Carolina CPESN Overview Enhanced Pharmacy Services: Services that transcend conventional requirements of an outpatient pharmacy program contract that are focused on improving clinical and global patient outcomes Examples include, but are not limited to: In-home delivery with patient status review Medication synchronization with clinical review Adherence packaging with patient coaching

25 Other Examples of Enhanced Services Naloxone dispensing Sterile compounding Pre-filled oral syringes Long-acting antipsychotic injections Medication disposal / take back site Emergency after hours dispensing Durable medical equipment Home visits Smoking cessation program Vital signs measurements Administration of standardized assessments (PHQ-2, pain assessments, etc)

26 Optimizing the Medical Neighborhood: Transforming Care Coordination Through the North Carolina Community Pharmacy Enhanced Services Network (CPESN)

27 Project Goals Goal #1: DETERMINE EFFECTIVE PAYMENT MODELS FOR ENHANCED SERVICES DELIVERY in a community pharmacy setting THAT LEAD TO HIGHER QUALITY, LOWER COST CARE DELIVERY Goal #2: DETERMINE REQUISITE WORKFLOWS, COMMUNICATION PATTERNS, AND TASK SHARING between community pharmacies, the primary care medical home and others participating in the medical neighborhood (care team) that lead to higher quality, lower cost care delivery Goal #3: DETERMINE REQUISITE HEALTH INFORMATION TECHNOLOGY UTILITIES that foster effective workflows, communications and task sharing between community pharmacies, the primary care medical home and others in the medical neighborhood (care team) that lead to higher quality, lower cost care delivery

28 Community Pharmacy Care Management (CPCM) CPCM Care management services provided locally by a community pharmacy in close coordination with other care team members, including other care managers that focus on optimal drug use. The objective of CPCM is to procure, update and re-enforce a team-based, patient-centered pharmacy care plan over time. This service line is longitudinal and coordinated with the rest of the care team.

29 The CPESN Model All patients filling prescriptions at the pharmacy Chronically ill patients who have selected a Pharmacy Home (specific attribution criteria applied to determine the pharmacy s panel) High risk chronically ill population in need of intensive services with follow up 29

30 Intensity Intensity Intensity Transformational Change in Frequency & Nature of Clinical Patient Interactions Part D CMR Time (6+ months) Initial CPESN attempts at Comprehensive Initial Assessments with Follow Up Time (6+ months) Current Model Time (6+ months)

31 1) Search based on map location Pharmacy Locator Connects Patients with Specific Medication Use Needs to CPESN Pharmacies 2) Search based on location and specific enhanced services

32 Growth of the CPESN Concept

33 Describe How Community Pharmacy s Effectiveness Will Be Measured

34 Performance Measurement: Shared Accountability for Global Outcomes

35 The Role of Patient Experience Patient experience vs. traditional patient satisfaction Patient s satisfaction with enhanced pharmacy services Patient s understanding of his/her medication regimen Self-efficacy / patient s ability to manage his / her own medications

36 Post Test: Question #1 What type of organizations should be seen as potential payers within the new healthcare landscape? A. Managed care organizations B. Accountable care organizations C. Commercial health plans D. Pharmaceutical manufacturers E. A and C F. All of the above

37 Post Test: Question #2 What type of performance measures will best help community pharmacy advertise its value to other members of the health care team? A. Medication adherence B. High risk medications C. CMR completion D. Medical utilization measures (e.g., total cost of care, hospitalizations) E. A, B, and C

38 Post Test: Question #3 What are examples of services that can improve the outcomes associated with prescription drug use? A. Monitoring of vital signs B. Medication synchronization C. Adherence packaging D. Smoking cessation program E. All of the above

39 Take Home Points Opportunities exist today for like-minded community pharmacies to come together in their state and begin to differentiate themselves through enhanced services that impact the patient s overall health outcomes and utilization The current value-based health care movement is ripe for these type of developments in community pharmacy

40 Speaker Contact Information Trista Pfeiffenberger The project described was supported by Grant Number 1C1CMS from the Department of Health and Human Services, Centers for Medicare & Medicaid Services.