Campaign for Meds Management (CMM) April 26, 2016
Housekeeping You will need to access your registration confirmation email and registration ID to login to WebEx Thank you for joining us in the WebEx Event Center Teleconference: 1-855-339-4595 Feel free to engage with the speakers at any time via the chat feature Questions and comments during the Facilitated Discussion portion: *1 2
Welcome Martin Hatlie, JD Consumers Advancing Patient Safety Rachel Digmann, PharmD Medication Safety & Program Lead QIN NCC - Telligen 3 Call materials will be posted to www.qioprogram.org
Method of Participation You must participate in the entire activity to receive credit. A statement of credit will be available upon completion of an online evaluation/claimed credit form. The link to the online evaluation will be provided after completion of the activity. If you have questions about this CME/CE activity, please contact AKH Inc. at service@akhcme.com. 4
CME/CE Information Physicians: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians. AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physician Assistants: NCCPA accepts AMA PRA Category 1 Credit from organizations accredited by ACCME. Pharmacists: AKH Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. AKH Inc., Advancing Knowledge in Healthcare approves this knowledge-based activity for 1.0 contact hour (0.1 CEU). UAN 0077-9999-16-035-L04-P; UAN 0077-9999-16-035-L04-T. Initial Release Date: 4/26/2016 5
CME/CE Information Nurses: AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. This activity is awarded 1.0 contact hour. Nurse Practitioners: AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider Number: 030803. This program is accredited for 1.0 contact hour which includes 0 hours of pharmacology. Program ID #21610-3. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standard Dietitians: AKH Inc., Advancing Knowledge in Healthcare is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 1.0 continuing professional education unit (CPEU) for completion of this program/material. CDR Accredited Provider #AN008. The focus of this activity is rated Level 2. Learners may submit evaluations of program/materials quality to the CDR at www.cdrnet.org. 6
Disclosure of Financial Relationships & Commercial Support Planners and faculty that do not have any relevant financial relationships to disclose: Rachel Digmann, PharmD, BCPS Martin J. Hatlie, JD Lisa Morrise, MArts LCDR Alister Rubenstein, PharmD, MPH John Scanlon, PhD Anita Thomas, PharmD Ensia Yaisrael AKH Inc., CRW & Associates and Telligen No commercial support was received for this activity. 7
Disclosure of Financial Relationships & Commercial Support Disclosures It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review. Disclosure of Unlabeled Use and Investigational Product This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Disclaimer This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant's misunderstanding of the content. 8
Intent of this Call Introduce the CMM Change Package Showcase effective self-management practices for effective use of opioids Expectations for voluntary participation in pilot sites Solicit interest and commitments to participate in CMM pilot phase 9
Who is on the Call? I am from a: Person & Family Engagement Organization/ Patient Advocate QIN-QIO PTN SAN Other (please specify in the chat box) 10
Self-Management Strategies with Opioid Use Ensia Yaisreal Sickle Cell Disease Advocate Lisa Morrise CMM Management Team 11
Ensia s Passions 12
What We Just Heard Ensia s Journey Patient Education occurs in the Pediatric Setting less common in the Adult Setting Ensia was taught self-advocacy skills in her home Patient Support Important for patients and providers to collaborate Treatment protocols can be developed based on the severity of symptoms How payers can get better outcomes and lower costs Search for best management options (recent option for Ensia was Hydroxyurea) Allow Case Management for developing plans for Medication Self- Management 13
Overview of the CMM Change Package 14 John Scanlon, PhD CMM Management Team
Medication Self-Management for Patients & Family, Moving to a Stable and Effective Structure Patient and Family Patient and family often cannot move into med self-management on their own. 15
Medication Self-Management for Patients & Family, Moving to a Stable and Effective Structure Patient and Family Patient and family and physician cannot move into med self-management on their own. Two points are not stable. Physician & Office Staff 16
Medication Self-Management for Patients & Family, Moving to a Stable and Effective Structure 17 With assessment and community support, there is a foundation Situation Assessment & Community Support Community Pharmacist Home Health Social Services Patient and Family Physician & Office Staff Three points give a base.
Medication Self-Management for Patients & Family, Moving to a Stable and Effective Structure Four players in alignment make it sustainable. Patient and Family Add the payer to form a stable structure! 18 Situation Assessment & Community Support Community Pharmacist Home Health Social Services Physician & Office Staff Payer
Medication Self-Management for Patients & Family, Moving to a Stable and Effective Structure Patient and Family 19 Situation Assessment & Community Support Community Pharmacist Home Health Social Services Physician & Office Staff Payer
Four Guides in the CMM Change Package A. Guide for Physicians B. Guide for Payers C. Guide for Assessment and Support D. Guide for Patients and Families 20
CMM Change Package to Include Tools Assembled from Existing Toolkits Examples: Partnering in Self-Management Support: A Toolkit for Clinicians, May, 2009, IHI, RWJ Foundation New Health Partnerships Information for People with Chronic Conditions Self-Management Support, 2011, IHI Patient Credentialing as a Population Health Management Strategy: A Diabetes Case Study, Population Health Management, 2014 21
CMM Change Package to Include Tactics Drawn from Case Studies A. Stories of How Physician Practices Set Up Patient and Family Self-Management Systems B. Stories of How Payers Support Patient and Family Self- Management C. Stories of Assessment and Support D. Stories of Patient and Family Self-Management E. Tools Pulled from Existing Self-Management Literature 22
CMM Story Development (to date) 23
CMM Guides Content Physician/Office Guide Establish the infrastructure to make self-management possible Secure assessment of patient & family readiness and ability to self-manage meds. Enable self-management with support, education, check-in Track the process and results of self-management by the patient and family 24 Patient/Family Guide Seek assessment of your readiness for med self-management Find and embrace support to master the medication program Build your personal medication self-management program Keep the med program visible and current
CMM Guides Content Payer Guide Segment patients by high risk of medication breakdown Get commitment from physician to pursue med self management Link patient and physician up with certified assessor. Track the process and results of self-management by patient and family Assessment & Support Guide Assess patient command of the condition and the medication program. Assess family structure and readiness for self-management. Other TBD 25
Range of Self-Management Strategies 26 Self-Management Support. June 2015. AHRQ, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/selfmgmt/index.html
IOM Operating Definitions http://www.nap.edu/catalog/11085/1st-annual-crossing-the-quality-chasm-summit-a-focus-on Patient Self-Management the tasks that individuals must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management, and emotional management of their conditions. Collaborative Self-Management Support the systematic provision of education and supportive interventions by health care staff to increase patients skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support. 27
Chronic Care Model 28
Collaborative Self-Management Support Practice Core Competencies http://www.ihi.org/resources/pages/tools/selfmanagementtoolkitforclinicians.aspx Describe and promote self-management by emphasizing the patient s central role in managing his/her health. Include family members at the patient s discretion. Build a relationship with each patient and family member. Explore patient s values, preferences, and cultural and personal beliefs. The patient and providers share Information and communicate in a way that meets the patient s and family s needs and preferences. Collaboratively set goal(s) and develop action plans. Document the patient s confidence in achieving goals, and use skill building and problem-solving strategies that help the patient and family identify and overcome barriers to reaching goals. Provide follow-up on action plans and connect the patient with community programs to sustain healthy behaviors. 29
Challenges to Patient Self-Management Perceived Challenge (Examples) Physical (disability) Psychological (depression, distress) Cognitive (health literacy, literacy) Economic (health insurance adequacy) Social and Cultural (isolation) Strategies for Overcoming Challenges (Examples) Structured Communication (motivational interviewing) Assessment Enhancing self-efficacy (goal setting, action plans) Ongoing support (practice follow up, peer support) 30 Helping patients with chronic conditions overcome barriers to self-care. 2012 - The Nurse Practitioner, 13 March 2012 - Volume 37 - Issue 3 - p 38 39
Motivational Interviewing DARN CAT Tool D Desire. Why do you want to make this change in how you take your medication? A Ability. If you decide to make this change, how would you do it? R Reasons. What are the most important benefits that you think you ll see from taking your medication better? N Need. How important is it to you to make this change? C Commitment. What do you think you will do? A Activating. What are you ready to do? T Taking steps. What are you already doing to be healthy? 31 Helping patients with chronic conditions overcome barriers to self-care 2012 - The Nurse Practitioner, 13 March 2012 - Volume 37 - Issue 3 - p 38 39
Patient and Care Partner Tools http://www.ihi.org/resources/pages/tools/self ManagementToolkitforClinicians.aspx 32
Tools for Pilot Site Work 33 http://www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/index.html
QIN-QIO, PfP and TCPI Support 34 Anita Thomas, PharmD QIO Medication Safety Lead LCDR Alister Rubenstein, PharmD, MPH Partnership for Patients & Transforming Clinical Practice Initiative
35 Participation in the CMM Pilot
CMM Pilot Site Criteria Four Sectors Engaged (Ideally): The patient and family caregiver that self-manage a complex medication program The physician practice responsible for the patient and the medication program The assessment and support sector that includes pharmacy and other sectors of the extended care team that makes self-management possible The payers involved in financing the overall care program 36
CMM Pilot Site Criteria Pilot Recruitment: CMM is voluntary not required, not a contract CMM is not research request is to use the Change Package, not test it CMM is a soft pilot Between June and December, our request is for pilot sites to use the Guide and give the QIN NCC and the CMM Steering Committee feedback on your use Measurement and reporting your feedback is the measurement. o o o Surveys by CMM Pilot site convenings via webinar to share feedback Participation and report out during NCC QIN-QIO events 37
CMM Pilot Site Expectations Three CMM Goals that Pilot Sites Help Achieve: 1. Assess the degree to which, and under what conditions, these sectors are able to act on the Guide 2. Improve the Guide based on feedback from the pilot participants 3. Create a revised version of the Guide and a spread strategy for a national spread campaign 38
CMM Pilot: Six Steps 1. Survey QIN-QIOs, HENs, TCPI PTNs, and AIMM for candidate pilot communities 2. Pilot sites commit to engage the four target sectors in the pilot communities 3. Enroll the three tracks in those communities ready to engage 4. Take the participants through the pilot activities in a series of monthly web-based work sessions 5. Capture feedback from each of the four sectors 6. Refine Change Package and design community-based spread strategy 39
Group Discussion What excites you most about participating in the CMM Pilot? What possibilities and opportunities do you see from CMM? 40
Closing Comments Anita Thomas, PharmD QIO Medication Safety Lead Rachel Digmann, PharmD Medication Safety & Program Lead QIN NCC - Telligen 41 Call materials will be posted to www.qioprogram.org
Join the Campaign If you are interested in joining the Campaign or want to be considered as a pilot site: Email Lisa Morrise at Lisa.Morrise@gmail.com OR call 800-506-4550 42
Call to Action: Join to Learn More! Invite others who are passionate about safe medication use to join the campaign Attend upcoming QIN-QIO events for local spread teams Keep an eye out for more information QIO Program website: http://qioprogram.org/campaign-meds-management 43
Save the Date! Join us for the next Campaign for Meds Management Call Tuesday, July 26, 2016 3:00-4:00 PM ET Registration is required! Register at https://qualitynet.webex.com/qualitynet/onstage/g.php?mti D=e3d3405bb75e67266e77aeae68431eae8 44
Thank you! This material w as prepared by Telligen, the Quality Innovation Netw ork National Coordinating Center, under contract w ith the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The 40 contents presented do not necessarily reflect CMS policy. 11SOW-QINNCC- 00752-04/21/16