Bob Davis, PharmD, FAPhA Professor and Chair, KPIC South Carolina Primary Health Care Association September 19, 2015

Transcription

1 Bob Davis, PharmD, FAPhA Professor and Chair, KPIC South Carolina Primary Health Care Association September 19, 2015 Myrtle Beach, SC

2 Kennedy Pharmacy Innovation Center Foundation established at the University of South Carolina in 2010 through alumni gift Fosters creativity and innovation by connecting passionate, forward-thinking, entrepreneurial pharmacy students, educators, and practitioners Develops and supports entrepreneurial programs, and exploration of new sustainable business models Transforms pharmacy practice into viable, effective patient-centered care model by providing tools, resources, and relationships

3 Disclosures Robert E. Davis declare(s) no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

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5 The Triple Aim Institute for Healthcare Improvement (IHI) 6

6 Industry Quality Programs Healthcare Effectiveness Data and Information Set (HEDIS) Consumer Assessment of Healthcare Providers and Systems (CAHPS) National Committee for Quality Assurance (NCQA) Health Resources and Services Administration (HRSA) Medicare Five-Star Ratings Health Outcomes Survey (HOS)

7 How is quality measured? Clinical Performance How well providers deliver specific patient services/processes. (immunizations, physicals) Outcome Measures Clinical performance measures of how well providers achieve results for specific patient services. (mortality rates, A1c) Patient Assessments Assessments by patients of how well providers meet healthcare needs from the patient s perspective. (satisfaction)

8 IOM Proposed Core Measures Preventative Prevention Immunizations Care Qualit y Access to care Safe Care Appropriate Treatment Unmet care Hospital infection rate Preventable hospitalizations Person-Centered Care IOM report: Vital Signs: Signs Core metrics.aspx Patient provider satisfaction

9 IOM Proposed Core Measures Healthy People Care Cost Engaged People Healthy behaviors Affordability Sustainability Individual engagement Community engagement BMI High spending relative to income Per capita spend on health care Health literacy Social support Measure what is important to patients

10 How is quality reported? Accreditation Certification process of competency, authority or credibility typically of facilities or organizations. Standards Joint Commission (JC) Report Cards Reporting clinical performance measures of how well organizations or providers deliver specific patient services. Outcomes National Committee of Quality Assurance (NCQA) Health Care Effectiveness Data and Information Set (HEDIS) Patient Ratings Assessments by patients of how well providers meet healthcare needs from the patient s perspective. Satisfaction Medicare Star Ratings

11 HRSA Quality Reporting Quality of Care Indicators Asthma Pharmacologic Therapy Coronary Artery Disease (CAD): Drug Therapy For Lowering LDL Cholesterol Ischemic Vascular Disease (IVD): Use of Aspirin or Other Antithrombotic Health Resources and Service Administration Medication Compliance Metrics: Diabetes (DM) Hypertension (HTN)

12 HRSA 2014 Health Center Profile

13 HEDIS Reporting Used by >90% health plans to measure care and service performance Compares health plan s performance "apples-toapples. Focuses improvement efforts Health issues addressed Asthma Medication Use include: Beta-Blocker after Heart Attack High Blood Pressure Comprehensive Diabetes Care Breast Cancer Screening Antidepressant Management Immunizations

14 XYZ Health Plan Health Plan Quality Reporting Axxxxx, MD Target Current Diabetes Care % poor control (<9.0%) >85% 73% % control (<8.0%) 65% 67% % control for select population (<7.0%) 40% 48% Hypertension % < 140/90 mm Hg 70% 83% Cholesterol Mgt % < 100 mg/dl 60% 68% Bxxxxx, MD Target Current Diabetes Care % poor control (<9.0%) >85% 75% % control (<8.0%) 65% 65% % control for select population (<7.0%) 40% 47% Hypertension % < 140/90 mm Hg 70% 72% Cholesterol Mgt % < 100 mg/dl 60% 72%

15 Five-Star Ratings Managed by CMS through contracted administrators Performance tied to Quality Bonus Payments (QBP) About 50% of Star Ratings measures are influenced by pharmacy Pharmacy Quality Alliance (PQA)-supported medication measures include: High-risk medications in the elderly (HRM) Beer s List Appropriate Treatment of Hypertension in Diabetics-ACEI & ARB Proportion of Days Covered (PDC)-Adherence for select chronic medications

16 Quality Management Plan Consistent with Triple Aim Comprehensive approach to Quality Management. Assists CHCs to integrate new programs and technologies with the primary care services.

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18 Why Pharmacists in Quality? Pharmacists are logical choices for engaging in quality management due to: Best core knowledge of medications Continuously monitor medication related literature Provide unbiased evaluation of new medications Predict and anticipate effects of medications Understand risk inherent in medication management Standardized medication management process experience Good collaborative and communication skills

19 Patient Centered Medical Home Quality and Safety

20 PCMH Quality Assurance Standards Developed by National Committee for Quality Assurance (NCQA) 1. Enhances access continuity 2. Identify and manage patient populations 3. Plan and manage care 4. Provide self-care support and community support 5. Track and coordinate care 6. Measure and improve performance

21 Quality Standards & Pharmacists PCMH 1: Enhance Access and Continuity Enhanced access to care and clinical advice (Productivity) Team-based care (standing orders, self management, refills) PCMH 2: Identify and Manage Patient Populations Clinical Data (Med Rec, allergies, adverse effects) PCMH 3: Plan and Manage Care Evidence-based Guidelines (medication related) Identify High Risk Patients Care Management (treatment goals, assessment of goals) Medication Management (Med Rec, Pt Rx Education, assess response to meds, document OTC, herbals, PCMH 6: and Measure compliance) and Improve Performance NCQA Standards 16

22 Engaging Pharmacists in Quality Key Tactics Join national quality associations Subscribe to newsletters and blogs Understand your practice s overall quality plan Volunteer to help shape quality plan Collaborate with quality management team Actively participate in quality committee/initiatives P&T Pain management Chronic care management Patient safety

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24 Informational Management Coordination (Continuity) Transfer of patient historical and personal information required to make appropriate health care decisions. Established plan of care responsive to needs of patient and is a consistent approach to the management of a condition. Relational (Interpersonal) Ongoing therapeutic relationship between a patient and providers characterized by trust and loyalty.

25 Collaborative Relationships Commitment to the relationship Individual characteristics Contextual factors Exchange characteristics Relationship expansion Exploration and trial Professional recognition McDonough & Doucette Model Journal American Pharmaceutical Association, 44(3), Professional awareness

26 Awareness Traditional pharmacist physician working relationship. Interactions are discrete, and short in duration. Refill request, drug-drug interaction. Professionally safe, routine, and defined by wellestablished expectations. Commitment to the relationship Relationship expansion Exploration and trial Professional recognition Professional awareness

27 Commitment Achieved when physician is convinced benefits outweigh risks. Relationship should involve a high level of interaction from both parties. Commitment reached if there is equity in effort toward relationship. A collaborative working relationship is a relationship in every sense of the word. Commitment to the relationship Relationship expansion Exploration and trial Professional recognition Professional awareness

28 Patient Activation and Patient Engagement Patient Activation Emphasizes patients willingness and ability to take independent actions to manage their health Patient Engagement Activation with interventions designed to increase engagement and promote positive patient behavior

29 Medication Management in a FQHC and PCMH

30 Ohio MTM Pilot in FQHCs Purpose: Expand medication management provided by pharmacists in Ohio FQHCs to reduce the burden of chronic disease. Goals: Increase the number of FQHC patients with: A1c <9% BP <140/90 Using pharmacist-led diabetes self management programs Avoided cost due to decreased ADEs, MRPs ED visits, hospitalizations Results at 6 months 42% of diabetic MTM patients were in control 50% of hypertensive MTM patients were in control 82 potential adverse drug events detected and remedied

31 Comprehensive Medication Management Pharmacists Key Daily Duties: Managing chronic patient medications Nutritional counseling Patient education on proper self medication Paul Fleming Ashton Glasgow Kerri Hatcher

32 Pilot Overview: PPCP-Trident Scope: To develop and evaluate collaborative, sustainable business model(s) for pharmacist provided Comprehensive Medication Management (CCM) services within a PCMH. Focus: Patients with diabetes, lipid disorders, hypertension, congestive heart failure, obesity, and multiple/complex therapies. Agreements: Memo of Understanding, Collaborative Practice Agreements, Scope of Practice, and Treatment Algorithms. Funding: BCBS SC MTM and KPIC supported pharmacist. Time: November 1, 2013 October 31,

33 Quality-A1c Improvement Patients with A1c >10.0 Patients with A1c > Mean A1c Improvement Mean A1c Improvement % % % Patients Improved 77.2% Patients Improved 202 Patient retrospective chart reviews Evaluation period November 2013-October 2014 Minimum 2 pharmacist visits and pre/post A1c

34 Quality-LDL Improvement Patients with LDL-C >130 Patients with LDL-C >80 Mean LDL Improvement Mean LDL Improvement % % % Patients Improved 79.1% Patients Improved 186 Patient retrospective chart reviews Evaluation period November 2013-October 2014 Minimum 2 pharmacist visits and pre/post LDL-C

35 Quality-HBP Improvement Patients with Systolic >140 Patients with Diastolic > Mean SBP Improvement Mean DBP Improvement % 10.1% % Patients Improved 81.3% Patients Improved 321 Patient retrospective chart reviews Evaluation period November 2013-October 2014 Minimum 2 pharmacist visits and pre/post BP

36 Satisfaction Willingness to Recommend/Refer Provide r 4.7 Patient 4.9 Staff % of patients volunteered they would change behavior based on pharmacist s coaching.

37 Cost Avoidance Month Encounters Interventions $ Avoidance Avoid/Encounter April $139,260 $ May $148,379 $ June $151,531 $ Typical Interventions Medication reconciliation Allergy identified, clarified or prevented Lab/test evaluation, patient consultation or recommendation Medication change of dose adjustment Patient counseling-self care: diet, exercise, checking blood sugars, OTC recommendation, smoking cessation Adverse effect identified/remedied Cost Avoidance from data of 3 independent studies by Suh, Classen and Bates and used by Pharmacy OneSource Quantifi software for reporting financial impact of pharmacist clinical interventions. Average intervention savings was $153.

38 2013 Payment/ Work Day Physician Productivity 2014 Payment/ Work Day % Increase Payment/ Work Day % Total Referrals to PharmD 2013 Q Q2 Provider Visits/Day Visits/Day MDA $2,741 $3, % % MDB $3,100 $3, % % MDD $2,602 $3, % % MDT $2,582 $3, % % MDV $2,878 $3, % % AVERAGE $2,781 $3, % % Contributing Factors: 1. Fee Increase November More New Patient Visits 3. More Complex Visits 20.6%

39 Pilot Overview: Mackey-Lancaster Scope: To develop and evaluate collaborative, sustainable business model(s) for pharmacist provided Comprehensive Medication Management (CCM) services within a PCMH. Focus: Patients with diabetes, lipid disorders, hypertension, congestive heart failure, obesity, and multiple/complex therapies. Agreements: Memo of Understanding, Collaborative Practice Agreements, Scope of Practice, and Treatment Algorithms. Funding: BCBS SC MTM and KPIC supported pharmacist. Time: November 1, 2013 October 31,

40 Quality-A1c Improvement Mackey Family Practice-Lancaster Patients with A1c >10.0 Patients with A1c >7.0 Mean A1c Improvement - PharmD % 10.2% Mean A1c Improvement - PharmD % Patients Improved 72.5% Patients Improved 0 80 Patient retrospective chart reviews Evaluation period November 2014-May 2015 Minimum one pharmacist visit and pre/post A1c

41 Anticoagulation Management Program 67 Unique Patients 411 Patient Visits Large VA Study 58%-Best Practice Rosendaal Method Low Range 2 High Range 3 Evaluation period November 2014-May 2015

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