9/25/15. Pharmacy Quality Measures: Financial Support. Learning Objectives. Speaker Disclosure. Access to Preferred Networks and Clinical Performance

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1 Pharmacy Quality Measures: Action Steps for Improvement Financial Support Financial support was provided for this activity through an unrestricted grant from Health Mart Systems, Inc. Christine Jacobson Wasatch Pharmacy Care 2 Speaker Disclosure Learning Objectives Christine Jacobson is an owner of a Health Mart pharmacy. The speaker otherwise does not report any actual or potential conflicts of interest in relation to this continuing pharmacy education activity. Off-label use of medications will not be discussed during this presentation. CEI has taken appropriate action for conflict resolution, including external review by a non-conflicted peer reviewer. Pharmacist Learning Objectives Explain why quality performance matters for health plans, pharmacies and patients Recall five key quality measures for pharmacies, performance goals and general action steps for improvement Evaluate your pharmacy s specific performance on the five key quality measures Develop a pharmacy-specific action plan to improve performance on a specific quality measure Technician Learning Objectives Explain why quality performance matters for health plans, pharmacies and patients List five key quality measures for pharmacies Assist the pharmacist in evaluating your pharmacy s specific performance on the five key quality measures 3 4 Personal Learning Objectives Access to Preferred Networks and Clinical Performance Three things you would like to learn today: Preferred networks will continue to grow Continued tradeoff of lower reimbursement rates for access to preferred networks Clinical performance is becoming increasingly important and Star Ratings are a focus area Clinical performance may be the best chance for independent pharmacies to compete 3. 5 Sanger-Katz, M. New York Times. A Health Trade-Off That s Here to Stay: Lower Cost, Limited Choice. July 29, Accessed 08/05/2014. McKinsey & Company. McKinsey Center for U.S. Healthcare Reform. Hospital networks: Updated national view of configurations on the exchanges June Accessed 08/05/

2 Why is Clinical Performance Important? Criteria for pharmacy inclusion in preferred networks Historic Future: Coverage Consumer brand Cost + Clinical performance Operational performance Certification / compliance Who is clinical performance important to? Payers and PBMs Pharmacies Patients Reid RO, Partha D, Howell BL, and Shrank WH. Association Between Medicare Advantage Plan Star Ratings and Enrollment. JAMA. 2013;309(3): Cost and Clinical Quality Criteria for Access to Preferred Networks Sponsor intends to limit the Preferred Network to pharmacies that can provide both the quality level of service and care reflected in the STAR activity and a competitive cost structure for medications Criteria Network scale Generic dispensing rate Marketing investment Competitive rates/open to new benchmarks Openness to clinical performance incentives Positively impact Star ratings Recent RFP example Network Expectation Broad beneficiary access to retail network Achieve industry standard GDR or higher Participate in / contribute towards marketing the plan Willingness to experiment Willingness to enter into pay-forperformance reimbursement model Ability to drive high performance on star ratings 8 Centers for Medicare and Medicaid Services (CMS) Star Ratings Annual rating system to grade Medicare plans 2015 bonus payments, based on 2014 ratings, which were based on data Star Ratings Measures Star Rating Performance Level Poor Below Average Average Above Average Excellent Centers for Medicare & Medicaid Services. Prescription Drug Coverage General Information. PerformanceData.asp. Accessed 08/06/ Star Ratings: What is the Same? 2015 Key Star Rating Measure Goals Four key Part D quality measures for pharmacies to focus on remain the same: Adherence: Proportion of Days Covered (PDC) PDC: Statins Alternative Therapy Use of High-Risk Medications in the Elderly Measure RASA PDC (ACE/ARB PDC) Goal Direction 5-Star Goal % 1 * 2015 Top 20% 2 ** 85% 92.3% PDC: Statins 83% 91 % PDC: Diabetes 81% 90.4% PDC: Oral Diabetes Medications High-Risk Medications in the Elderly 7% 3.3% PDC: Hypertension (Renin-angiotensin system antagonists or RASA) enters for Medicare and Medicaid Services. Part C and D Performance Data Star Ratings Measure List. Accessed 08/05/ *Based on 2015 CMS 5-Star Goals for MA-PD plans, subject to change with each plan year, and in addition, individual payers may set their own goals relative to specific initiatives **Top 20% of retail pharmacies as reflected in EQuIPP (Data Range: October 2014-March 2015). Centers for Medicare and Medicaid Services. Part C and D Performance Data. Trends in Part C & D Star Rating Measure Cut Points. Accessed 5/30/15. Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at (Data Range: 2015). Accessed 05/30/

3 Star Ratings: What Is Changing? Centers for Medicare and Medicaid Services (CMS) has made the following changes: Retired Diabetes Treatment Measure New Full Measure Comprehensive Medication Review New Display Measure Statin Use in Diabetes Quality Measures: Expansion Expansion of quality measures to new populations Accreditation Commercial Health Insurance Exchanges Medicaid Display 2017 Full PQA Quality Connection. PQA Adherence Measure to be included in 2015 Quality Rating System Beta Test Measure Set. August 5, Accessed 08/05/ Adherence: Proportion of Days Covered Quality Measures: Action Steps for Improvement How is PDC calculated? Percentage of Medicare Part D patients 18 years of age or older covered by prescription refill records for the same medication or another in the therapeutic category during the measurement period Only patients with at least 2 fills of the intervention drugs are included What medications are included? Statins Oral Diabetic Medications Renin-angiotensin system (RAS) antagonists Centers for Medicare & Medicaid Services. Medicare 2015 Part C & D Star Rating Technical Notes. Accessed 08/30/ Adherence: Action Steps Adherence: Action Steps Identify non-adherent patients Targeted interventions Run reports Proactive drug utilization review Discuss with patient Leverage behavioral coaching Health Mart. Pharmacy Quality Measures: Improving Performance Playbook. Reviewed by Pharmacy Quality Solutions. Available at: Accessed 08/09/ Based on cause(s) for non-adherence, select the right tool or action: Cause for Non-Adherence Do not know why I need to take the medication Forget to order refills Forget to take each day Inconvenience of multiple medications and multiple trips to pharmacy Intolerable side effects Cost Solution Disease-state medication counseling using motivational interviewing approach Use electronic refill reminders Dose reminders, or if multiple meds, compliance packaging Medication synchronizations Therapeutic interchange/prescriber collaboration Therapeutic interchange, formulary review, patient assistance programs 18 3

4 9/25/15 High-Risk Medications (HRM) in the Elderly High-Risk Medications (HRM) in the Elderly: Action Steps How is it calculated? Patient identification Percentage of patients 65 years of age or older who received two or more fills of a prescription for a high risk medication during measurement period Prospective is key! Discuss with patient Prescriber communication What medications are included? Specific list of high risk medications in the elderly (subset of Beers Criteria) Example included below, full list included as Appendix Evidence: Beers Criteria Update Centers for Medicare & Medicaid Services. Medicare 2015 Part C & D Star Rating Technical Notes. Accessed 08/30/14. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc Available at: Accessed 08/07/ The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc Available at: Accessed 08/07/ Key Takeaways on Impacting the Measures Diabetes treatment Adherence High-risk medications Retired: Shift focus to other measures and CMR completion Personalizing the solution and consistent follow-up Prevention of fill or refill is key Health Mart. Pharmacy Quality Measures: Improving Performance Playbook. Reviewed by Pharmacy Quality Solutions. Available at: Accessed 08/09/14. EQuIPP : Evaluating Pharmacy Performance 21 Who has EQuIPP access to see their pharmacy specific performance? EQuIPP: Store Selection of Goal Set Getting Started: Select CMS Threshold (5-Star Goals) Taking Performance to the Next Level: Select Top 20% 23 Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at

5 EQuIPP: Pharmacy Performance Report Trend Line Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 25 Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 26 Pharmacy-Specific Performance Goal and Gap Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 27 Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 28 Versus Others Analyze Performance Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 29 Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at

6 Analyze Performance Pharmacy Performance Improvement Example Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 31 Sample Pharmacy Performance Report Action Steps What? Patient identification How? Within workflow Outside of workflow Completing targeted interventions Pharmacy management system reporting Vendor solutions Resources Measure-specific HRM list Patient target lists Action Steps Action Steps What? Discussion of potential risks with patient How? Leveraging behavioral coaching techniques Open ended questions Resources Coaching guides Behavioral coaching education What? Prescriber communication How? Consider leveraging a prescriber fax template 3-day follow-up call Special outreach to select prescribers office Resources Review evidence-based guidelines Fax templates 6

7 Sample Pharmacy Performance Improvement Quality Performance Action Planning Evaluating Your Pharmacy Performance Take Action Exercise Write in your pharmacy s performance scores Consider Which measures is your pharmacy doing well in? Which measures is your pharmacy below goal on? How many patients would you have to impact to get to goal on those measures? Consider pharmacy specifics that may be impacting your numbers Circle the measure(s) that your pharmacy would like to improve on Select an initial action step(s) CE Claim Credit Instructions Questions? CE can be redeemed with The Collaborative Education Institute (CEI) at Follow the instruction sheet and enter the unique code provided for this specific program and date Redeem your CE as soon as possible but no longer than 60 days from today CPE Access Codes: (Case sensitive) Pharmacists Technicians c2n8c t3jzp 42 7

8 9/25/15 THE HEALTH MART STRATEGY We re leveling the playing field so you can grow your business. Health Mart is the largest network of independent pharmacies in the nation. We re strong, yet flexible, and we re here to fuel your success. HEALTH MART CALL TO ACTION THE HEALTH MART DIFFERENCE Gain Access to Preferred Networks Bring Patients to Your Store Expand Your Services for More Revenue BUILT ON THE STRENGTH OF McKESSON Count on Reliable Distribution ROAD TO IMPROVED PHARMACY PERFORMANCE: KEY RESOURCES* YOUR PHARMACY S PERFORMANCE ADHERENCE SOLUTIONS TOOLBOX PROMOTIONAL TOOLBOX CO-PILOT Pharmacy Quality Measures: Driving Improved Pharmacy Performance Playbook (with case studies) Health Mart University: CE courses on quality measures, health coaching, MTM, Med Sync, disease state-specific, and more EQuIPP Enrollment How to Read Your EQuIPP Dashboard Guide Health Mart MRA Program (AccessHealth ) Adherence Performance Solution (McKesson Pharmacy Systems & Automation) Behavioral Coaching: Pharmacy Intervention Program Medication Synchronization Medication Therapy Management Refill and Pill Reminders: Your Pharmacy OnlineSM Health Mart Marketing Hub Health Mart Exclusive Partnership: Pharmacy Development Services (PDS) SyncRx and SyncRx + HEALTH MART EXCLUSIVE Physician Outreach Program Improve Your Bottom Line Boost Your Efficiency Plan for Your Future HEALTH MART: TOP 20% PHARMACIES ACTION PLANNING AND EDUCATION TOOLBOX HEALTH MART EXCLUSIVE Optimize Your Generics HEALTH MART EXCLUSIVE * For additional resources and education please visit Health Mart Operations Manual & Health Mart University Health Mart Named Pharmacy Innovator of the Year by Chain Drug Review! HEALTH MART: TOP 20% + PHARMACIES WITHIN 5% 47 8

9 9/25/15 Early Bird Registration Open Now! Register by March 20 and Save $100! ACTION STEPS 1 2 Monitor your pharmacy s specific performance with EQuIPP Enroll if you haven t already included in Health Mart and AccessHealth memberships! Check your Pharmacy Performance Report monthly Utilize your Quality Improvement Action Plan to begin taking action in the next 30 days Visit to learn about discounted pricing, our schedule of events, and to register for the show! Complete available Medication Therapy Management Case 3 Learn, Collaborate and Network Mirixa: or Outcomes: or QUESTIONS? Contact your Retail Sales Manager or HealthMartOperations@McKesson.com 9