UHCTransitions Pharmacy Module

Transcription

1 UHCTransitions Pharmacy Module Review daily to help improve medication adherence for your patients. UHCTransitions is UnitedHealthcare s convenient online tool that can help you identify and address open care opportunities for your patients who are our Medicare Advantage Prescription Drug Plan members. The tool s Pharmacy Module allows daily pharmacy claim information to be compiled so you can easily see which plan members have an upcoming or past due refi ll. You can also: View who may be a candidate for a 90-day supply of their medication. See who has open care opportunities tied to these quality measures: Statin Use in Persons With Diabetes (SUPD) Statin Therapy for Patients With Cardiovascular Disease (SPC) Medication Therapy Management Program Completion Rate for Comprehensive Medication Reviews (CMR) Get high-risk medication alerts. Add notes to track your efforts. This quick reference guide can help you get the most out of the Pharmacy Module. Step 1: Go to the medication adherence landing page. First, start by logging in to UHCTransitions every day at uhc.healthcollaborate.com. Once you re logged in, follow these instructions to see which of your patients are at risk for non-adherence to their medications: Under the Quality drop-down, select Member Rx Adherence to view your patient list. PATH Doc #: PCA _

2 Patients listed as highest priority have a refi ll past due date and, by default, are at the top of the list. Patient information is sorted lowest to highest by allowable days remaining the number of days they can miss before they become non-adherent for the year. The next priority are patients with refi lls that are due in seven days or less from the current date. They re also sorted lowest to highest by allowable days remaining. Past due medications are displayed in Red text with a count of the days past due. Medications that are coming due are shown in Yellow text with a count of the days before the next refi ll is due. Information provided for each patient includes: First and last name Date of birth Adherence alerts showing past due or coming due refi lls for cholesterol (statin), diabetes and/or hypertension (RAS antagonist) medications High-risk medication alerts if a high-risk medication was fi lled A 90-day supply opportunity if the last refi ll of a medication was for less than 90 days SUPD, SPC and CMR care opportunity alerts If a patient is taking two oral diabetes medications and is timely with one but not the other, an alert won t display for the second untimely medication. However, the prioritization will still apply to the second medication and the patient may appear high on the list despite not having any displayed alerts. For more details, click on the Rx icon and view Refill History see Step 2 for instructions. Icons appear if an action is added for an alert. No icon appears if there hasn t been an action taken. See Step 3 for details on how to document any follow-up with your patient to help improve their medication adherence. Indicates Follow-up required. Indicates Action taken. Within the Member Rx Adherence page, columns can be sorted or fi ltered by: Care provider 90-day supply opportunity Prescribing care provider Patient fi rst name Health system/facility Patient last name Medication category Date of birth Doc #: PCA _

3 Step 2: Review alert details adherence scorecard and refill history. For a more detailed patient view, click on the Rx icon underneath each patient s name on the Member Rx Adherence page. The Patient Rx Scorecard will appear with updated information about the patient s medication adherence, and show any open SUPD, SPC and CMR care opportunities. The Rx Scorecard for each category includes: Current proportion of days covered (PDC) patient must fi nish the year with 80 percent to be considered adherent Allowable days remaining before a patient becomes non-adherent number will go down every day a refi ll is past due Days missed year-to-date number of days the patient has missed on the medication so far this year SUPD, SPC and CMR care opportunity alerts From the Patient Rx Scorecard, click on the Patient Refill History tab to see when a patient last fi lled their prescription. An Adherence Category will display next to each name with adherence information for the cholesterol, diabetes and/or hypertension medications they re taking. SUPD, SPC and CMR care opportunity alerts will also show in the Patient Refill History view. Doc #: PCA _

4 To view alert details, click on the Patient Refill History tab. Refi ll past due or coming due adherence alerts will show: Drug name Most recent fi ll date and next refi ll due date Quantity and days supply Prescribing care provider Pharmacy name/id Pharmacy phone number Adherence category Refi ll status Action if an action has been taken and documented High-risk medication alerts will simply display as HRM under the HRM column, while SUPD, SPC and CMR alerts will be on their own lines. At the bottom of the Patient Refill History tab, you can: Exclude Patient Hide a patient from all views for 30 days. For Part D medication adherence, hiding a patient from view or documenting that they no longer take a medication won t remove them from the measure. Add a Note View and/or add free text notes. To include a note, select Medication/Pharmacy from the drop-down menu. Type your free text in the Add a Note box and click Submit. To view a note, click on the Notes tab. Review Patient Demographics Click to be redirected to general patient information. Doc #: PCA _

5 UHCTransitions Pharmacy Module Section 3: Manage alerts and document action taken. The Pharmacy Module also allows you to track the actions you ve taken when following up with your patients about their medication adherence, or high-risk medication, SUPD, SPC and/or CMR care opportunities. To get started, go to the Patient Refill History tab and click the Manage button on the right side. The following alert details will appear, from top to bottom: Adherence scorecard same information as the Patient Rx Scorecard SUPD, SPC and CMR general information about the care opportunity Adherence and high-risk medication drug information including refill status and 90-day supply opportunity alert, if appropriate List of actions previously documented for this alert Doc #: PCA _ Action Taken section 5

6 To document any actions you ve taken with your patient, click the applicable boxes under the Action Taken header more than one selection can be made. Choosing one of the following actions will hide the patient s adherence alert from view, but won t remove them from the adherence numerator. For Part D medication adherence, a patient can t be removed from the numerator once indexed into the measure. Patient no longer prescribed medication Patient contacted pays cash at pharmacy receives free samples receives prescriptions from VA performs pill splitting To save action(s), click Add Action. If you checked Follow up is needed, a follow-up icon will appear with the alert on the patient list. If any other action is checked, an action taken icon will appear with the alert on the patient list. If a patient has multiple alerts, click on Previous or Next to view the next one and document any actions taken. Doc #: PCA _

7 Section 4: Export reports. Reports can be exported from the Pharmacy Module to share medication alerts and adherence information as needed. Exports can be sent to an Excel or CSV fi le. To begin your export, go to the Member Rx Adherence page from the Quality drop-down and click on Export on the left side. Choose between All Records that match current fi lters or Checked Records Only. Select the fi le format from the drop-down and then click Export. Information provided within the report includes: Member and primary care provider details For each adherence measure: Alerts refi ll past due or coming due Pharmacy information Adherence information proportion of days Prescribing care provider covered (PDC), allowable days remaining (ADR) Documented actions taken and days missed Drug information name, quantity/days supply (DS), last refi ll date and refi ll due date High-risk medication drug name, date of refi ll, prescribing care provider and documented actions taken 90-day supply opportunity alerts SUPD, SPC and CMR care opportunities Contact us to learn more. For more information about how our programs can help support your patients who are UnitedHealthcare Medicare Advantage Prescription Drug Plan members, please contact your UnitedHealthcare representative. Doc #: PCA _

8 Sample export report: Member Name Member DOB Primary Provider Primary Practice PDC ADR Drug name Pharmacy Name/Phone <Patient Name> 08/31/1946 <Provider Name> <Practice Name> <Patient Name> 08/31/1946 <Provider Name> <Practice Name> <Patient Name> 03/24/1950 <Provider Name> <Practice Name> Refi ll Past Due (37 days late) 50% 0 59 CRESTOR TAB 40MG 30/30 03/31/ /30/2016 MARANA HEALTH CENTER INC/ <Patient Name> 07/18/1940 <Provider Name> <Practice Name> Refi ll Past Due (13 days late) 50% 0 60 PRAVASTATIN TAB 80MG 30/30 04/06/ /06/2016 WALGREENS /(520) <Patient Name> 11/13/1940 <Provider Name> <Practice Name> Refi ll Past Due (11 days late) 61% 0 72 SIMVASTATIN TAB 40MG 28/28 04/28/ /26/2016 QUALITY PHARMACY 2/(401) <Patient Name> 01/03/1939 <Provider Name> <Practice Name> Days missed <Patient Name> 07/27/1958 <Provider Name> <Practice Name> Refi ll Past Due (4 days late) 50% 0 59 ATORVASTATIN TAB 40MG 30/30 05/13/ /12/2016 WAL-MART PHARMACY /(520) Quantity/ DS Date of l a s tr e fi l l Next refill due Prescribing Provider Actions Taken Diabetes Actions Taken High Risk Medications HRM Drug Name HRM Date of last refill HRM Prescribing Provider HRM Actions Taken 90 Days Supply Opportunity 2016/09/02 13:52 - Transport Consider switch to 90 Days Supply if appropriate 2016/09/02 13:52 - Transport Consider switch to 90 Days Supply if appropriate <Prescribing Provider Name> Consider switch to 90 Days Supply if appropriate <Prescribing Provider Name> Consider switch to 90 Days Supply if appropriate <Prescribing Provider Name> 2016/08/29 16:23 - Follow Consider switch to 90 Days Supply if appropriate Consider switch to 90 Days Supply if appropriate /(520) <Prescribing Provider Name> Consider switch to 90 Days Supply if appropriate Doc #: PCA _