16 th Annual IHA Stakeholders Meeting Session 2C

Transcription

1 16 th Annual IHA Stakeholders Meeting Session 2C September 19, 2017 Hilton Los Angeles Airport Thank you to our Content Partner:

2 Medication Adherence AppleCare Pharmacy Programs Confidential and proprietary. Do not distribute.

3 AppleCare Medical Group Medical Group and IPA servicing Los Angeles and Orange County 100,000 members Senior, Dual, Commercial, Medi-Cal Commercial HMO ACO 900 Primary Care Physicians and Specialists Clinical infrastructure Hospitalist Program Pharmacists, Social Workers, Nurse Case Managers Disease Management and Preventative Care Programs High Risk and Post-Discharge Clinic Remote Monitoring Confidential and proprietary. Do not distribute.

4 Our Service Area Landmark Cities Downey Lynwood Long Beach Lakewood Anaheim Whittier Confidential and proprietary. Do not distribute. 4

5 Our Health Plan Partners Confidential and proprietary. Do not distribute. 5

6 Confidential and proprietary. Do not distribute. 6

7 Medication Adherence Program Confidential and proprietary. Do not distribute. 7

8 Pharmacy Processes 1. Annual Preparation Internal 2. Monthly 90-day Supply Provider Outreach 3. Weekly Adherence Member and Pharmacy Outreach Confidential and proprietary. Do not distribute. 8

9 Beginning of the Year Preparation Focus on 90-Day Supply Eligibility Review Provider Templates Pharmacy Outreach Internal Education Reduce adherence calls Patient savings on medications Answer questions about the communication Develop staff relationships Work closely with pharmacy partners to address any concerns and answer questions about working with AppleCare Educate member and provider facing teams about processes and objectives Source/Footnotes Confidential and proprietary. Do not distribute. 9

10 Monthly 90-Day Supply Provider Outreach Continuous follow-up (return rate: 75 %) Pull Adherence Reports by Health Plan Organize by 90-day supply eligibility Monthly fax outreach to provider offices Fax provider approval to pharmacy and follow-up with member Confidential and proprietary. Do not distribute. 10

11 90-Day Supply Provider Communication Confidential and proprietary. Do not distribute. 11

12 AppleCare 90-Day Supply Improvement SCAN Results 90 day-supply rates up 14.3% YOY Received award for most improved group on adherence rates Confidential and proprietary. Do not distribute.

13 Weekly Adherence Member Outreach Telephonic outreach reminders to members Pull Adherence Reports by Health Plan Organize by: 1. % Adherence determine likelihood of meeting quality criteria 2. Refill Due Date Telephonic/fax outreach to pharmacy to initiate refill Confidential and proprietary. Do not distribute. 13

14 Questions? Mary Tadros, PharmD Confidential and proprietary. Do not distribute. 14

15 Welcome to DESERT OASIS HEALTHCARE As a member of the desert community for over 35 years, Desert Oasis Healthcare is dedicated to the health and well-being of our neighbors throughout the Coachella Valley.

16 Pharmacists: A Seat at the Table Lindsey Valenzuela, Pharm.D. BCACP Administrator Population Health and Prescription Management (PHARxM) Desert Oasis Healthcare

17 Desert Oasis Healthcare: HPN Affiliate Medical group with a wraparound IPA established ,000 MediCare Advantage 30,000 HMO Commercial 7,000 Nextgen ACO 1 st Pharmacist hired in 2005 Pharmacist managed clinics under established collaborative practice agreements Anticoagulation Diabetes Coronary Artery Disease (CAD) Hepatitis C (Center of Excellence collaboration with FQHC) Heart Failure COPD Antimicrobial Stewardship Primary Care Refill Program Medication Access HEDIS/5 Star Quality Support

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19 Steps to Success Evidence Based Interdisciplinary Protocol Quality Improvement Council Review EHR Documentation Information Shared with PCP Board Certified Pharmacists Residency Trained Specialized Certifications Medical Director Mentor Champion Expert Pilot the Program Build Success then Expand Measure Outcomes Scale Using Technology Pharmacists Patient Care Process

20 COPD Adherence Health Education Anticoagulation Cost Time Complexity Frustration Patient Primary Care Physician Collaboration Medication Reconciliation and Review Population Health & Prescription Management (PHAR x M) Cardiology Hepatitis C Diabetes

21 DIABETES MANAGEMENT Reduction in all cause and diabetes related hospitalizations Compared to baseline, the percentage of patients with HbA1c at or below guidelines (<7%) increased from 1.5% to 19.2% Optimal LDL (<100mg/dL) increased from 62.1% to 80.6%. Sustainability in HbA1c shown with 7.4% before discharge and 7.4% six months after discharge

22 DIABETES MANAGEMENT Mean initial HbA1c 10.6%, HgA1c at 180 days 8.6% Poorly controlled seniors reduced from 21% to <9% (5 STAR rating in achieved) 48% of all patients had an HbA1c <9% after 90 days. Patient Satisfaction: 100% of patients surveyed would recommend this program to friends and family (n = 100)

23 PRIMARY CARE REFILL PROGRAM

24 PRIMARY CARE REFILL PROGRAM 36% 30 Days 98% 30 Days 16% 30 Days 55% 30 Days In order for prescription medications to be effective at treating illnesses, patients must: Fill the prescription given to them by the physician Routinely take the medication as directed by the physician: Quantity of medication to be taken Number of times per day medication is to be taken Time(s) of day medication is to be taken Refill the medication as needed in order to take the medication as long as recommended by the physician. If a patient fails to do any of these medication adherence is less than perfect.

25 PRIMARY CARE REFILL PROGRAM

26 CARDIOLOGY MULTIDISCIPLINARY MANAGEMENT Cardiologist NP RN Technician Support Enrolled in the Refill Program

27 Patients trust their PCP PCP RELATIONSHIP: KEY TO OUR SUCCESS Patients expect that their PCP, specialist, case manager, Pharmacist, etc. communicate on a regular basis Reinforcing treatment plans Direct conversation regarding concerns or discrepancies Document sharing Shared success

28 Virtual Program Concept, Staffing & Results Khanh Nguyen, PharmD Director, Quality Programs & Pharmacy Operations Clinical Support Hill Physicians Medical Group September 2017

29 Hill Physicians Medical Group Organizational Overview Independent Physician Organization (IPA) founded in 1984 Largest IPA in Northern California in Northern California counties Over 4,000 providers 250K Commercial, Medicare Advantage & Medi-cal members 120K Attributed PPO 29

30 Virtual Program Hospital Discharges Health Plan Providers Drug Consult / Dz Management Initial assessment Routine f/u (1-6 weeks) Full med review, prn Interventions Med optimization Lifestyle goal setting Labs/PCP appts Therapeutic Interchange Patient Case Management Patient & Family Reports & Analytics Virtual Pharmacist Interventions Med optimization per protocol Patient consult note PCP appts POS alerts Generic Rx switches Drug consult Labs f/u Providers 30

31 Current Staffing & Documentation Process # of pharmacist FTEs: 4.5 # of Integrated Practices: 108 # of Integrated Physicians: 150 # unique pts outreached/fte/year: 500 # of interventions/fte/year: 2000 Outreach Document Report Patient communication via phone or secure Provider messaging via EHR All interventions documented in Case Management module Interventions documented in a pharmacy assessment template Output reports updated daily & run as needed Updated outcome reports currently underway 31

32 Patient Based Outcomes

33 2014 VRx Program Patient Based Outcomes Medication Adherence n = 712, pre- and post-vrx med management or med rec; meds for chronic conditions Pre-VRx Intervention PDC: 47% (45%, 48%) Post-VRx Intervention PDC: 63% (61%, 65%) IP Readmissions & ED Visits (Med Rec 30 Days After Discharge) n = 133, case-control matching on similar disease burden, demographics Readmission Rate 30 day re-admission odds: 5.4 times as high for patients not receiving Med Rec 90-Day Incidence Rate: those who received Med Rec were re-admitted 30% less often ED Visit Rate: 30 day post-dc ER visit odds: 2.75 times as high for patients not receiving Med Rec 30-Day Incidence Rate: patients who received Med Rec visited the ED 76% less often IP Readmissions & PCP Follow-up (Med Rec 14 Days After Discharge) n = 83, case-control matching on similar disease burden, demographics Trend towards reduced 30-day readmissions: 8.4% vs. 13.3% (p=0.39) Statistically significant shorter time to PCP follow up: 14.1 vs days (p<0.001) 33

34 2016 Quality Measure Compliance 90% Medication Adherence: Proportion of Days Covered by Patient 80% 79% 70% 60% 63% 60% Pre Intervention Post Intervention 50% 47% 40% 30% 2014 Data 2016 Data Cost savings of $500 per compliant patient *Express Scripts, Report: Adherence to Diabetes Rx, Aug 25,

35 Diabetic Dz Management 2016 Results 9.2% 9.0% HbA1c Change 9.1% 70% 65% % of Patients with any HbA1c Reduction 64% 8.8% 8.6% 8.4% 8.5% Control 60% 55% 50% 56% 8.2% 8.2% VRx Cohort 45% 8.0% Pre-enrollment 6 months postenrollment 40% VRx Cohort Control Every 0.1% decrease in A1c results in an average of ~$1,000/year savings* *The Cost and Quality Gap in Diabetes Care: An Actuarial Analysis, Milliman Client Report,

36 2016 Utilization ER & IP Admits Relative Risk of an ER and IP Visit (RR, 95% CI) ER readmit 90-Days Post Outreach IP readmit 90-Days Post Outreach An ED or IP readmission is less likely to happen in the VRx Integrated group if the RR is < 1 36

37 Practice Based Outcomes

38 2014 VRx Program Practice Based Outcomes Quality Measure Compliance Overall compliance rates are significant at the 90% confidence level VRx Practices: 88% (87%, 90%), Control Practices: 83% (81%, 84%) Year Screening VRx (% Compliance) Control (% Compliance) p-value Breast Cancer 83.6% 78.6% < Cervical Cancer 63.2% 57.1% < Colorectal Cancer 78.6% 70.2% < Breast Cancer 86.2% 78.3% < Cervical Cancer 68.0% 59.9% < Colorectal Cancer 80.3% 70.2% < % 85% 80% 75% 76.7% 76.3% Generic Prescribing Rates 82.1% 80.0% 85.2% 83.8% 87.1% 85.7% Every 1% increase is associated with $1-2 reduction in overall Rx PMPM 70% P < for VRx Practices Control Practices 38

39 2014 VRx Program Practice Based Outcomes Impact on Risk Adjusted TCC PMPM Trends % vs. 10.5% increase in VRx vs. Control From 2013 to Results: VRx Practices Control Practices TCC calculation is risk-adjusted & includes: All medical & pharmacy costs (Rx claims, office-based services, injectables, etc.) Facility cost ($750 ED visit & $4,000 IP day) estimate based on proxies from IHA Value-Based P4P program TCC calculation could not account for out of network cost differences 39

40 VRx 2016 Statistics-Engagement Integrated with 108 practices at Hill 68% patient engagement rate 75% provider recommendation acceptance rate* * Acceptance rate is based on a sampling of intervention cases 40

41 2016 Quality Measure Compliance (Hill Network) 100% 90% 2016 Quality Measures Outreach Practices Non-Outreach Practices * 80% * * 70% * * 60% 50% 40% Asthma Med Ratio Diab Management Two HbA1c tests 2016 Breast Cancer Screening Colo Cancer Screening PDC for Oral Diabetes Medications PDC for Renin Angiotensin System (RAS) Antagonists PDC for Statin Medications * Indicates statistical significance MY 2016 No statistical difference for any measure in 2015

42 Quality Measure Compliance Quality Composite Score CMS Star & P4P Measures 76% 74% VRx Cohort 1 72% 70% 71.1% 73.3% 71.1% VRx Cohort % 68% 67.9% 66% 64% 64.3% Case Matched Control 62% 60% VRx SF Community VRx UCSF Case Matched Control 42

43 68% 71% 71% 72% 73% 81% 2016 Quality Measure Compliance Proportion of Days Covered by Practice NETWORK PRACTICES V RX PRACTICES COHORT 1 V RX PRACTICE COHORT 2 Medication Adherence patient outreach (all regions) n = 719, pre- and post-vrx med management adherence consultations Pre-VRx Intervention PDC adherence: 60% Post-VRx Intervention PDC adherence: 69% 43

44 Percent Generic 89% VRx Practices Case Matched Control 88% 88.3% 87% 86% 87.2% 86.4% 86.6% 85% 85.0% 85.5% 84% 83% Aug Onboarding of VRx Cohort 82% 2015 Q Q Q Q Q Q Q Q2 Every 1% increase is associated with $1 - $2 reduction in overall Rx PMPM 44

45 Pharmacy PMPM Trends $ VRx Integrated Case Matched Control $ $99.83 $90.00 $85.93 $80.00 $70.00 $66.97 $60.00 $57.67 $

46 Total Cost of Care Trends $150 VRx Integrated Case Matched Control $145 $ $140 $135 $130 $ $125 $120 $ $ $115 $