2015 Annual Convention

Transcription

1 2015 Annual Convention Date: Tuesday, October 13, 2015 Time: 8:00 am 9:30 am Location: Gaylord National Harbor Resort and Convention Center, National Harbor 2 Title: Activity Type: Speaker: Benefit from Patient Care Opportunities in Diabetes Sponsored by Merck ACPE # L04-P 0.15 CEUs ACPE # L04-T Application-based Patrick Devereux, PharmD, FMS Pharmacy Bri Morris, Associate Director of Strategic Initiatives, NCPA Pharmacist and Pharmacist Technician Learning Objectives: Upon completion of this activity, participants will be able to: 1. Discuss patient care services that can improve outcomes for patients with Diabetes. 2. Relate methods to tie adherence with advanced patient care services in the diabetic population. 3. Outline business aspects of an advanced diabetes adherence program. Disclosures: Patrick Devereux declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Bri Morris declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. NCPA s education staff declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. NCPA is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is accredited by NCPA for 0.15 CEUs (1.5 contact hours) of continuing education credit.

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3 Benefit from Patient Care Opportunities in Diabetes Sponsored by Merck Bri Morris, Pharm.D. Patrick Devereux, Pharm.D. Disclosures Patrick Devereux declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Bri Morris declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Learning Objectives Discuss patient care services that can improve outcomes for patients with diabetes Relate methods to tie adherence with advanced patient care services in the diabetic population Outline business aspects of an advanced diabetes adherence program 1

4 Why is it so expensive? It is a complicated disease state. Tight glycemic control primarily due to medications, insulin Micro and macrovascular complications Comorbid conditions 2

5 Enter Community Pharmacist #1 most accessible healthcare provider Knowledge and skillset to make a difference Opportunity to impact patient s life Targeted Patient Care Services Immunizations DME Testing supplies DSME A1C testing Adherence as the Foundation Improve patient outcomes Provide quality care Adherence to oral diabetic as stars measure CMR completion rate Transforms workflow 3

6 Short fill/align a patient s medications to same day of month (known as appointment date) Contact patient one week before appointment date to discuss any changes Pharmacist discusses patient s medications, MTM, patient services Order medications, fill prescriptions, check for clinical issues, get prior authorizations Remind patient of appointment day Opportunity to Target Diabetes Patients Multiple chronic conditions (2.6 on average) Sync diabetes patients to same week Diabetes education classes Pharmacist/nutrition consults DME support Bulk inventory Value of a Diabetic Patient Multiple chronic medications 2.6 additional illnesses $1 DM rx $1.05 on non DM rx $ 1 DME $0.70 on non DM related supplies Family and caregivers as additional patients * The Full Value of a Diabetes Patient. Smart Retailing Rx. Feburary 6, Accessible at: care counseling/the full value of a diabetes patient/ 4

7 Pharmacy as a Healthcare Destination Immunizations DME Testing supplies Education classes A1C testing Lab testing Front-end items (sugar free items, diabetic cough medicines, foot creams, compression stockings) Becoming a Diabetes Destination Patrick Devereux,PharmD FMS Pharmacy Bessemer, Alabama FMS Pharmacy Located in Bessemer, AL approximately 15 miles west of downtown Birmingham Filling an average of 220 RXs per day 2 full time pharmacists 2 full time technicians 1 technician/delivery driver/ front end 1 part time faculty member pharmacist 1 clinical pharmacist(split between 3 stores) 5

8 FMS Pharmacy Patient Care Offerings Appointment based med sync model Adherence packaging Delivery MTM Immunizations Accredited diabetes education program and diabetes prevention program DME to include diabetic shoes and inserts Compounding FMS Pharmacy Patient Care Offerings On the horizon Insulin pump training Expanded genetic testing offering It all starts with setting the vision Define what you are good at and what you are passionate about. Engage staff to be involved in this new service Share why it is important and why it matters Educate them about the vision and how they will help achieve it Teach them the selling points so they can engage customers as well 6

9 Set goals for new services Based on the vision, define which clinical services you can accomplish with the current dispensing needs Start small and set written goals with dates and a written plan to accomplish them Write the metrics that your are measuring Designate space Key roles for everyone in pharmacy First define the WHY, then the WHO Show staff that the new service is important because What is our service doing for patients and how can your participation improve their lives? Patient Care Services Adherence Diabetes Education Diabetic Shoes/DME Immunizations 7

10 Diabetes Education Located in Jefferson County Alabama 0 accredited programs within 12 miles of store Currently providing DSME services to patients in our 3 pharmacies Accredited programs may bill Medicare and some others Working to gain provider status for DSME with other payers Accreditation for Diabetes Education Curriculum must be accredited to be eligible for payment from Medicare or other third party payors Acceptable accreditation organizations: AADE, ADA, IHS Both use the National Standards for Diabetes Education Program is accredited, NOT the pharmacy Separate from pharmacy Will use pharmacy NPI# for billing Accreditation for Diabetes Education Accreditation requirements vary per organization Organization will look at your curriculum outline, teaching materials, policies and procedures, patient charts, quality improvement measures Many organizations have curriculums available as well as accreditation standards 8

11 Payment for services and codes Services are paid based on HCPCS codes Medical billing codes submitted on a HCFA form or similar acceptable electronic format G0108= individual diabetes education (billed in 30 minute increments) Ex: Billing 4 units corresponds to 2 hours G0109= group diabetes education(billed in 30 minute increments) Payment for services and codes Allowable per unit vary per state and payer Medicare currently pays around $48.75 per unit for individual (G0108) Medicare currently pays around $15.25 per unit for group (G0109) Many payers base their allowable on Medicare allowable We have had no problem charging patients for this service if they have an insurance we cannot bill. Potential Cost Considerations Cost for accreditation and membership Build out for classroom space Marketing Printing materials for patients Staff costs to cover the pharmacy 9

12 Potential Revenue Considerations Revenue from program Prescriptions from patients in the program Testing supplies Immunizations Diabetic footwear/dme Front end sales related to diabetes Diabetic Shoes/DME Providing testing supplies Critically important to make smart purchasing decisions wih regards to Medicare reimbursement Custom fit diabetic shoes/inserts MANY challenges but can be financially and clinically rewarding with the right person heading it up Diabetic Shoes Medicare covers 1 pair of diabetic shoes and 3 pairs of custom inserts every year Must meet certain criteria set by Medicare Must be provided by a qualified provider/fitter DMEPOS may be qualified by completing a manufacturer approved course Patient criteria AND documentation requirements are located in Medicare LCD policy for diabetic shoes and custom inserts 10

13 Diabetic Shoes Shoes are custom fit Impression of the bottom of foot is taken for custom inserts Qualified shoe fitter does a foot inspection to look for abnormalities and accommodates for those when ordering shoes and inserts Revenue Considerations Billing and documentation are not for the faint of heart Medicare LOVES to audit shoes and inserts Be sure you have all of your documentation in place before you place order and patient picks up shoes Get familiar with LCD and Medicare DMEPOS regs Audit your charts yourself before sending the shoes in for order Revenue Considerations Can be profitable Gross profit can vary from $150 to $250 depending on payer. Can get them every calendar year under Medicare if they continue to meet criteria Highly recommend having a staff member with the key responsibility of providing this service Also able to cross promote other services such as adherence and diabetes education 11

14 Immunizations Flu, Pneumonia are particularly important in diabetes patients Important to acquire standing orders for these and other vaccines Able to administer vaccines while diabetes patients are in for other clinical services Utilize automated call out options for our diabetic patients with our sync software Promoted when patients are scheduled for pick up Adherence services The cornerstone of our clinical branding Currently 150 patients synced Utilize the appointment based model and adherence packaging when necessary Promoted throughout our diabetes services and throughout our marketing Simplified for patient AND pharmacy staff Adherence services Utilizing a med sync appointment based model to have a once a month pick up Utilizing software to organize our appointments on a calendar Checked by staff and planned a week in advance on our pharmacy calendar Automated call out option for our non-sync patients to notify patients when maintenance medications are coming up 12

15 Adherence Services Technicians and support staff involved throughout the process Mapping out meds with patient for short fills or for packaging Promoting the service Calling patients and scheduling Adherence service process Staff identifies patient who may benefit during dispensing or patient may approach us to sync or package their meds Patient scheduled to bring their medications in for review Pharmacist intervention when necessary For packaging patients, med administration times are reviewed Adherence service process Appointment day is scheduled with patient Patient receives a call prior to pick up date and meds are reviewed Other needs are assessed such as immunizations, testing supplies 13

16 Adherence makes business sense A small increase in adherence can add up to increased gross profit dollars per patient Increased volume of refills means increased gross profit dollars Increased volume of refills means increased number of times per year patient visits pharmacy possibly leading to increased gross profit dollars in front end merchandise Key to financial success with adherence means creating an increased number of efficient visits per patient How many dollars per patient can an increase in adherence generate? Defining objective measures PDC= proportion of days covered Calculated by looking at the total days supply of medicine and dividing it by total days in the time period being monitored Example: Patient has refilled their 30 day medication only twice in a 90 day time period 60 days medication possession= 0.66 (66%) 90 day time period Using this formula, patient only had possession of their medication 66% of the time Defining objective measures GP per day per patient Calculated by taking the total daily GP per patient Example: If a patient s prescriptions total up to a total gross profit for the pharmacy of $240.00/month and we divide that by 30 days, you will get $8.00 per day for that patient Using our previous example, the patient who had their medication for 60 days yielded a total GP of $ If they had their medication 80 of those 90 days the GP goes up to $ Finding the adherence barrier for this patient could add up to an extra $ for your time and effort 14

17 Case Studies Patient 1 Adherence barrier was remembering to take their medications Detected by our staff who noticed gaps in refills We sat down and created a CMR(comprehensive medication record) to break down each medication by time of day Patient was interested in weekly adherence packaging to keep up with their medications Case Studies Patient s initial PDC was 34% for 8 month period prior to intervention Patient s PDC jumped to 97% for 8 month period since intervention In addition to the patient feeling better, the gross profit generated was vs Does not take into account extra front end sales generated from increased visits per year Patient 2 Barrier was having to make multiple trips to the pharmacy per month Would often delay refilling meds until other meds were due to be refilled to save gas. Still a work in progress Still working with this patient to get his PDC even better By syncing his medicines up at the same time, we have increased his PDC from 68% to 78% 15

18 Does a 10% increase in PDC matter? This patient s gross profit per day for all of his medications= $8.28 per day We increased his medication possession ratio 10% over a 6 month period Prior to intervention he had possession of his medicine 122 days(68%), then total GP= $1, By increasing his PDC to 78% (140 days) then total GP= $1, If we can get him to 88% then GP= $1, Growth related to adherence Improvement in script count Adherence model and call out in the first few months brought the rx count up 200/month than before program existing patients Servicing 3 group homes because of this capability Physicians are referring Approached by a regional Medicare Advantage plan to assist their physicians with adherence since their numbers are affected as well Growth related to adherence Star rating for pharmacy has increased from 3 stars for our patients to 4.16 stars Unclear as to what this impact means right now Tremendous improvement in efficiency Less panicked phone calls and rushing in before closing with refills Creates a nice even flow in the pharmacy Room for more growth Better inventory management and fewer partial fills 16

19 What s the bottom line? Increase in script count has lead to increased revenue, increased rebates, and a healthier bottom line Appointment/sync based model can help you do more with same staff level leading to a healthier net profit and overall productivity Less stress staff, less chaotic atmosphere Diabetes Care on the Horizon Insulin pump training Pharmacists can become certified pump trainers Involves pharmacist being trained by insulin pump company and being paid to train the patient Intensive training for pharmacist About 4 hours or so with patient Still a work in progress in our pharmacy Questions? Contact Information: Bri Morris, Pharm.D. National Community Pharmacists Association Alexandria, VA bri.morris@ncpanet.org Patrick Devereux, Pharm.D. FMS Pharmacy Bessemer, AL rpdevereux@gmail.com

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